MEDICARE: DR. JON EBERT HIGHUM 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	2084P0800X	Psychiatry Physician	G65798	CA

Other Identifiers

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

General Provider Information

NPI Number	:	1538215603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JON EBERT HIGHUM M.D.

Provider Business Mailing Address
First Line	:	7777 ALVARADO RD # 255
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91941-3616
Country	:	US
Telephone Number	:	619-461-9353
Fax Number	:	619-443-8338

Provider Business Practice Location Address
First Line	:	7777 ALVARADO RD # 255
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91941-3616
Country	:	US
Telephone Number	:	619-461-9353
Fax Number	:	619-443-8338

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

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	07/09/2007

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