MEDICARE: JON PERLSTEIN M.D.

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	2086S0127X	Trauma Surgery Physician	A061414	CA

General Provider Information

NPI Number	:	1316993199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JON PERLSTEIN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 2366
Second Line	:
City	:	ROCKLIN
State	:	CA
Zip	:	95677-8366
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 MEDICAL PLAZA DR
Second Line	:	TRAUMA SERVICE
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-3037
Country	:	US
Telephone Number	:	916-781-1382
Fax Number	:	916-781-1383

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

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	01/05/2010

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