Healthcare Provider Details

I. General information

NPI: 1386833945
Provider Name (Legal Business Name): DAVID SIZEMORE JR MD A PROFESSIONAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2007
Last Update Date: 08/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 SAINT JOHN PL
HEMET CA
92543-4422
US

IV. Provider business mailing address

1030 SAINT JOHN PL
HEMET CA
92543-4422
US

V. Phone/Fax

Practice location:
  • Phone: 951-929-2300
  • Fax: 951-929-0584
Mailing address:
  • Phone: 951-929-2300
  • Fax: 951-929-0584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG041592
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberG041592
License Number StateCA

VIII. Authorized Official

Name: DR. DAVID ALDEN SIZEMORE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 951-929-2300