Provider Demographics
NPI:1992808331
Name:LOMBARD, JOHN TIMOTHY (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:TIMOTHY
Last Name:LOMBARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:J TIMOTHY
Other - Middle Name:
Other - Last Name:LOMBARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:10978 DONNER PASS RD
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161
Mailing Address - Country:US
Mailing Address - Phone:530-582-1212
Mailing Address - Fax:530-582-1171
Practice Address - Street 1:10978 DONNER PASS RD
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161
Practice Address - Country:US
Practice Address - Phone:530-582-1212
Practice Address - Fax:530-582-1171
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC38687207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
942847013OtherGROUP TAX ID NUMBER
00C386870Medicare ID - Type Unspecified
A36982Medicare UPIN