MEDICARE: JOHN ROBERT DEBANTO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	G86400	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033175922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN ROBERT DEBANTO MD

Provider Business Mailing Address
First Line	:	9802 STOCKDALE HWY
Second Line	:	STE 102
City	:	BAKERSFIELD
State	:	CA
Zip	:	93311-3653
Country	:	US
Telephone Number	:	678-897-3726
Fax Number	:

Provider Business Practice Location Address
First Line	:	1412 1/2 CALUMET AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-5494
Country	:	US
Telephone Number	:	678-897-3726
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2006
Last Update Date	:	04/27/2017

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Directions to “ JOHN ROBERT DEBANTO MD” Practice Location

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