Healthcare Provider Details

I. General information

NPI: 1710034970
Provider Name (Legal Business Name): JOHN R DEXTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 LOMA VISTA RD STE 205
VENTURA CA
93003-1582
US

IV. Provider business mailing address

5142 HOLLISTER AVE # 113
SANTA BARBARA CA
93111-2526
US

V. Phone/Fax

Practice location:
  • Phone: 805-585-3086
  • Fax:
Mailing address:
  • Phone: 805-696-7923
  • Fax: 805-636-7921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG38860
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: