Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | G56162 | CA |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | G56162 | CA |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | G56162 | CA |
NPI | 1447363668 |
---|---|
Provider Name | John Kenneth Merson |
First Address | Walnut Creek, CA 94598-8396 |
Second Address | Concord, CA 94520 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2006 |
Last Update Date | 17/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200037192 | RAILROAD MEDICARE (01) | |
E24835 | (02) |