NPIMap

Organization Active NPI

Jerry Judd Pryde Jr., M.D., P.C.

  • Specialist
  • Los Angeles, CA
National Provider Identifier
1891908018
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
A60849 Issued in CA
Legal business name
JERRY JUDD PRYDE JR., M.D., P.C.
Practice address
8631 W 3Rd St
Suite 915E
Los Angeles, CA 90048-5901
Phone
(310) 423-2182
Fax
(310) 423-0154
NPI assigned
May 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jerry Judd Pryde, M.D.
Title
Owner
Phone
(310) 423-2182

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X A60849 CA Primary

Addresses

Primary practice location

8631 W 3Rd St
Suite 915E
Los Angeles, CA 90048-5901

Mailing address

PO Box 18796
Beverly Hills, CA 90209-4796
Phone (310) 423-2182

National Provider Directory

National Provider Directory
Tax ID family
Jerry Judd Pryde Jr MD PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1891908018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 18796",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902094796",
            "telephone_number": "310-423-2182",
            "fax_number": "310-423-0154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8631 W 3RD ST",
            "address_2": "SUITE 915E",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900485901",
            "telephone_number": "310-423-2182",
            "fax_number": "310-423-0154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERRY JUDD PRYDE JR., M.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PRYDE",
        "authorized_official_first_name": "JERRY JUDD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "310-423-2182",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "A60849",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.