Provider Demographics
NPI:1699760975
Name:NAYDUCH, JOHN ROSS (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ROSS
Last Name:NAYDUCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:114 MISSION RANCH BLVD
Mailing Address - Street 2:STE 10
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2186
Mailing Address - Country:US
Mailing Address - Phone:530-894-0500
Mailing Address - Fax:530-345-8532
Practice Address - Street 1:114 MISSION RANCH BLVD
Practice Address - Street 2:STE 10
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2186
Practice Address - Country:US
Practice Address - Phone:530-894-0500
Practice Address - Fax:530-345-8532
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2009-08-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG80231207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G802310Medicaid
CA00G802310Medicare ID - Type Unspecified
CA00G802310Medicaid