Provider Demographics
NPI:1194760751
Name:EBAUGH, JOHN E (DPM)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:EBAUGH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:81709 DR CARREON BLVD
Mailing Address - Street 2:SUITE D3
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-5509
Mailing Address - Country:US
Mailing Address - Phone:760-863-0070
Mailing Address - Fax:760-863-0048
Practice Address - Street 1:81709 DR CARREON BLVD
Practice Address - Street 2:SUITE D3
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5509
Practice Address - Country:US
Practice Address - Phone:760-863-0070
Practice Address - Fax:760-863-0048
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAE4495213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E44950Medicaid
CA5222190001Medicare NSC
CAY05745Medicare UPIN
CAZZZ28495ZMedicare PIN