Physician Compare National (NPI:1700857083)

HEALTHCARE PROVIDER: JOHN B COLLET JR. D.P.M.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1700857083
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9931264777
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20090211000608
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	COLLET
	Individual professional last name
Provider First Name	JOHN
	Individual professional first name
Provider Name Suffix Text	JR.
	The name suffix of the provider if the provider is an individual. The name suffix is a ''generation-related'' suffix, such as Jr., Sr., II, III, IV, or V.
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1980
	Individual professional's medical school graduation year
Primary Specialty	PODIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1643 E MAIN ST
	Group Practice or individual's line 1 address
City	VENTURA
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	930013307
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8056484105
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	050394
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	COMMUNITY MEMORIAL HOSPITAL SAN BUENAVENTURA
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y