MEDICARE: DR. ADRIAN ENAD CARREON M.D.

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	207R00000X	Internal Medicine Physician	A54997	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	:	1679598536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADRIAN ENAD CARREON M.D.

Provider Business Mailing Address
First Line	:	410 E YOSEMITE AVE
Second Line	:	SUITE A
City	:	MERCED
State	:	CA
Zip	:	95340-8220
Country	:	US
Telephone Number	:	209-384-9108
Fax Number	:	209-384-0580

Provider Business Practice Location Address
First Line	:	3605 HOSPITAL RD
Second Line	:	SUITE F
City	:	ATWATER
State	:	CA
Zip	:	95301-5173
Country	:	US
Telephone Number	:	209-381-0184
Fax Number	:	209-381-0190

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	07/08/2007

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