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NPI Code Detail

MEDICARE: JOHN WILLARD NESSON M.D.

MEDICARE: JOHN WILLARD NESSON 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
12085R0202XDiagnostic Radiology PhysicianA22120CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2ZZZ04744ZOTHERCABLUE SHIELD
3A22120OTHERCABLUE CROSS

General Provider Information

NPI Number : 1487667101
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN WILLARD NESSON M.D.
Provider Business Mailing Address
First Line : 333 N SANTA ANITA AVE
Second Line : SUITE 9
City : ARCADIA
State : CA
Zip : 91006-2863
Country : US
Telephone Number : 626-445-0004
Fax Number : 626-445-0302
Provider Business Practice Location Address
First Line : 150 PIONEER LN
Second Line :
City : BISHOP
State : CA
Zip : 93514-2556
Country : US
Telephone Number : 760-873-2171
Fax Number : 626-445-0302
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/14/2006
Last Update Date : 07/08/2007

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