MEDICARE: DR. JOHN LEE MERSHON MD

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	207V00000X	Obstetrics & Gynecology Physician	01055667A	IN

General Provider Information

NPI Number	:	1649763244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN LEE MERSHON MD

Provider Business Mailing Address
First Line	:	3023 WOODSHORE CT
Second Line	:
City	:	CARMEL
State	:	IN
Zip	:	46033-3643
Country	:	US
Telephone Number	:	317-432-5534
Fax Number	:

Provider Business Practice Location Address
First Line	:	2596 N GIRLS SCHOOL RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46214-2105
Country	:	US
Telephone Number	:	317-244-3387
Fax Number	:

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

Provider Enumeration Date	:	06/08/2018
Last Update Date	:	06/08/2018

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