Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | G76369 | CA |
NPI | 1396786901 |
---|---|
Provider Name | Dr. John Terry Dearborn |
First Address | Menlo Park, CA 94027-4127 |
Second Address | Menlo Park, CA 94027-4127 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 19/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G60912 | (02) | CA |
ZZZ02726Z | (02) | CA |
ZZZ02727Z | (02) | CA |