Provider Demographics
NPI:1366526550
Name:STONEBURNER, JOHN M JR (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:STONEBURNER
Suffix:JR
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 1:23451 MADISON ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4763
Mailing Address - Country:US
Mailing Address - Phone:310-378-7373
Mailing Address - Fax:310-378-1098
Practice Address - Street 1:23451 MADISON ST
Practice Address - Street 2:SUITE 300
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4763
Practice Address - Country:US
Practice Address - Phone:310-378-7373
Practice Address - Fax:310-378-1098
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG54697208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G546970Medicaid
CAA93314Medicare UPIN
CAG54697Medicare ID - Type Unspecified