MEDICARE: JOHN DESNOYERS MD, INC.

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	207P00000X	Emergency Medicine Physician	G81907	CA

General Provider Information

NPI Number	:	1366848517
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN DESNOYERS MD, INC.

Provider Business Mailing Address
First Line	:	PO BOX 90544
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92169-2544
Country	:	US
Telephone Number	:	619-461-1898
Fax Number	:	619-461-0198

Provider Business Practice Location Address
First Line	:	4370 LA JOLLA VILLAGE DR
Second Line	:	400
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-1249
Country	:	US
Telephone Number	:	619-461-1898
Fax Number	:	619-461-0198

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOHN DESNOYERS
Credential	:	MD
Telephone Number	:	619-461-1898

Provider Enumeration Date	:	11/17/2014
Last Update Date	:	11/17/2014

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