Provider Demographics
NPI:1023033412
Name:HADORN, JOHN RUZICK (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RUZICK
Last Name:HADORN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 DESERT GARDENS DR
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-9404
Mailing Address - Country:US
Mailing Address - Phone:760-337-8644
Mailing Address - Fax:
Practice Address - Street 1:2311 DESERT GARDENS DR
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-9404
Practice Address - Country:US
Practice Address - Phone:760-337-8644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG592502085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology