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NPI Code Detail

MEDICARE: JOHN PENDLETON M.D.

MEDICARE: JOHN PENDLETON 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
1207Q00000XFamily Medicine PhysicianA91072CA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
4ZZZ18742ZOTHERCAISSUER MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1326030024
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN PENDLETON M.D.
Provider Business Mailing Address
First Line : 1179 N MCDOWELL BLVD
Second Line :
City : PETALUMA
State : CA
Zip : 94954-6559
Country : US
Telephone Number : 707-559-7500
Fax Number : 707-559-7620
Provider Business Practice Location Address
First Line : 1179 N MCDOWELL BLVD
Second Line :
City : PETALUMA
State : CA
Zip : 94954-6559
Country : US
Telephone Number : 707-559-7500
Fax Number : 707-559-7620
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2005
Last Update Date : 09/20/2019

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Directions to “ JOHN PENDLETON M.D.” Practice Location

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