Healthcare Provider Details

I. General information

NPI: 1750513636
Provider Name (Legal Business Name): JOHN SAUNDERS SILVERTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2009
Last Update Date: 08/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3133 W MARCH LN SUITE 1040
STOCKTON CA
95219-2336
US

IV. Provider business mailing address

3133 W MARCH LN SUITE 1040
STOCKTON CA
95219-2336
US

V. Phone/Fax

Practice location:
  • Phone: 209-952-2251
  • Fax: 209-952-2282
Mailing address:
  • Phone: 209-952-2251
  • Fax: 209-952-2282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA32133
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: