MEDICARE: MR. JOHN MORRELL SUNDERSON PA-C

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	363A00000X	Physician Assistant	PA10555	CA

General Provider Information

NPI Number	:	1497808513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN MORRELL SUNDERSON PA-C

Provider Business Mailing Address
First Line	:	7265 N 1ST ST
Second Line	:	SUITE 105
City	:	FRESNO
State	:	CA
Zip	:	93720-2956
Country	:	US
Telephone Number	:	559-431-8181
Fax Number	:	559-438-3060

Provider Business Practice Location Address
First Line	:	7265 N 1ST ST
Second Line	:	SUITE 105
City	:	FRESNO
State	:	CA
Zip	:	93720-2956
Country	:	US
Telephone Number	:	559-431-8181
Fax Number	:	559-438-3060

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

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	07/08/2007

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