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General NPI Number Information
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NPI Number | 1255319869
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Entity Type | Individual
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Provider Name | JOHN B SLEDGE III M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/04/2006
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Last Update Date | 06/17/2024
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Provider Practice Location Address
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Address Line | 1018 S GRETNA GREEN WAY
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City | LOS ANGELES
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State | CA
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Zip | 90049-5831
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Country | US
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Telephone | 781-254-7599
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Fax |
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Provider Business Mailing Address
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Address Line | 1018 S GRETNA GREEN WAY
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City | LOS ANGELES
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State | CA
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Zip | 90049-5831
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Country | US
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Telephone | 781-254-7599
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | MD.205141
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number | 80940
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | 80940
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | G172374
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License Number State | CA
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