MEDICARE: MR. JOHN MATTHEW DENNIS CAS REG.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	1838 REG.	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1838 REG.	OTHER	CA	CAS REG.

General Provider Information

NPI Number	:	1225162480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN MATTHEW DENNIS CAS REG.

Provider Business Mailing Address
First Line	:	PO BOX 221
Second Line	:
City	:	SHINGLE SPRINGS
State	:	CA
Zip	:	95682-0221
Country	:	US
Telephone Number	:	530-677-8029
Fax Number	:

Provider Business Practice Location Address
First Line	:	2914A COLD SPRINGS RD
Second Line	:
City	:	PLACERVILLE
State	:	CA
Zip	:	95667-4220
Country	:	US
Telephone Number	:	530-642-1715
Fax Number	:	530-642-2064

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	07/08/2007

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