MEDICARE: DR. JOHN J. MCNERNEY JR. 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	17464	AZ

General Provider Information

NPI Number	:	1568469583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN J. MCNERNEY JR. M.D.

Provider Business Mailing Address
First Line	:	3040 N SWAN RD
Second Line	:	SUITE B.
City	:	TUCSON
State	:	AZ
Zip	:	85712-1225
Country	:	US
Telephone Number	:	520-327-3454
Fax Number	:	520-327-3431

Provider Business Practice Location Address
First Line	:	3040 N SWAN RD
Second Line	:	SUITE B.
City	:	TUCSON
State	:	AZ
Zip	:	85712-1225
Country	:	US
Telephone Number	:	520-327-3454
Fax Number	:	520-327-3431

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

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	01/10/2011

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