Provider Demographics
NPI:1396786901
Name:DEARBORN, JOHN TERRY (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:TERRY
Last Name:DEARBORN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1706 EL CAMINO REAL STE 101
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94027-4127
Mailing Address - Country:US
Mailing Address - Phone:650-325-1395
Mailing Address - Fax:650-326-2019
Practice Address - Street 1:1706 EL CAMINO REAL STE 101
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94027-4127
Practice Address - Country:US
Practice Address - Phone:650-325-1395
Practice Address - Fax:650-326-2019
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG76369207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG60912Medicare UPIN
CAZZZ02726ZMedicare UPIN
CAZZZ02727ZMedicare UPIN
CAZZZ49013ZMedicare ID - Type UnspecifiedFREMONT ORTHOPAEDIC'S #