Healthcare Provider Details

I. General information

NPI: 1972569499
Provider Name (Legal Business Name): JOHN O MISSIRIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 12/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 SULLIVAN AVE STE 402 THE ORTHOPAEDIC GROUP OF SF INC
DALY CITY CA
94015-2224
US

IV. Provider business mailing address

1800 SULLIVAN AVE STE 402 THE ORTHOPAEDIC GROUP OF SF INC
DALY CITY CA
94015-2224
US

V. Phone/Fax

Practice location:
  • Phone: 650-992-7700
  • Fax: 650-756-6254
Mailing address:
  • Phone: 650-992-7700
  • Fax: 650-756-6254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA36762
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: