MEDICARE: JEDIDIAH M MONSON 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	2085R0001X	Radiation Oncology Physician	G83275	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00G832750	OTHER	CA	BLUE SHIELD CA PROVIDER #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	5795635	OTHER	CA	AETNA PROVIDER #
4	1489286	OTHER	CA	CIGNA PROVIDER #

General Provider Information

NPI Number	:	1669455390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEDIDIAH M MONSON MD

Provider Business Mailing Address
First Line	:	PO BOX 25100
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93729-5100
Country	:	US
Telephone Number	:	559-326-1222
Fax Number	:	559-421-7004

Provider Business Practice Location Address
First Line	:	7130 N MILLBROOK AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93720-3347
Country	:	US
Telephone Number	:	559-326-1222
Fax Number	:	559-326-1225

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

Provider Enumeration Date	:	11/28/2005
Last Update Date	:	10/09/2025

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