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NPI Code Detail

MEDICARE: JON MARTEL GRAZER M.D.

MEDICARE: JON MARTEL GRAZER 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
1208200000XPlastic Surgery PhysicianA55421CA

General Provider Information

NPI Number : 1922077577
Entity Type Code : Individual
Provider Name (Legal Business Name) : JON MARTEL GRAZER M.D.
Provider Business Mailing Address
First Line : 400 NEWPORT CENTER DR
Second Line : SUITE 302
City : NEWPORT BEACH
State : CA
Zip : 92660-7601
Country : US
Telephone Number : 949-644-1240
Fax Number : 949-644-9274
Provider Business Practice Location Address
First Line : 400 NEWPORT CENTER DR
Second Line : SUITE 302
City : NEWPORT BEACH
State : CA
Zip : 92660-7601
Country : US
Telephone Number : 949-644-1240
Fax Number : 949-644-9274
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2006
Last Update Date : 08/17/2010

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