MEDICARE: DR. JOHN F SHEGA 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	174400000X	Specialist	G40700	CA
2	207ND0101X	MOHS-Micrographic Surgery Physician	G40700	CA
3	207NS0135X	Procedural Dermatology Physician	G40700	CA
4	207N00000X	Dermatology Physician	G40700	CA
5	207NI0002X	Clinical & Laboratory Dermatological Immunology Physician	G40700	CA

General Provider Information

NPI Number	:	1366432312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN F SHEGA M.D.

Provider Business Mailing Address
First Line	:	2710 HEALTH CENTER DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-2761
Country	:	US
Telephone Number	:	858-292-7525
Fax Number	:

Provider Business Practice Location Address
First Line	:	2710 HEALTH CENTER DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-2761
Country	:	US
Telephone Number	:	858-292-7525
Fax Number	:

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

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	04/07/2016

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