Provider Demographics
NPI:1104898675
Name:DISIERE, JOHN ELDRED (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ELDRED
Last Name:DISIERE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3116 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-5638
Mailing Address - Country:US
Mailing Address - Phone:707-444-3885
Mailing Address - Fax:707-444-7843
Practice Address - Street 1:3116 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-5638
Practice Address - Country:US
Practice Address - Phone:707-444-3885
Practice Address - Fax:707-444-7843
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC42437208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery