1518156090 NPI number — JOHN M. DEACON, M.D., INC.

Table of content: (NPI 1518156090)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518156090 NPI number — JOHN M. DEACON, M.D., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN M. DEACON, M.D., INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518156090
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1878
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GOLETA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93116-1878
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-696-7921
Provider Business Mailing Address Fax Number:
805-964-6946

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
351 S PATTERSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA BARBARA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93111-2403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-696-7920
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/19/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DEACON
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
805-964-3838

Provider Taxonomy Codes

  • Taxonomy code: 207PE0005X , with the licence number:  A66064 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)