MEDICARE: MR. JOHN DENSMORE PA

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

General Provider Information

NPI Number	:	1841962198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN DENSMORE PA

Provider Business Mailing Address
First Line	:	4001 W MCNICHOLS RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48221-3038
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1842 BUENAVENTURA BLVD
Second Line	:
City	:	REDDING
State	:	CA
Zip	:	96001-3700
Country	:	US
Telephone Number	:	530-986-9160
Fax Number	:

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

Provider Enumeration Date	:	10/04/2021
Last Update Date	:	03/09/2026

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Directions to “ MR. JOHN DENSMORE PA” Practice Location

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