Provider Demographics
NPI:1043229222
Name:AGNEW, JOHN S (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:AGNEW
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 1:3160 FOLSOM BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5219
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3160 FOLSOM BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5219
Practice Address - Country:US
Practice Address - Phone:916-733-5336
Practice Address - Fax:916-733-5385
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG331062083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMCMG167000OtherWESTERN HEALTH ADVANTAGE
CA0679168OtherCIGNA
CA1508OtherINTERPLAN
CA4507057OtherAETNA
CA1089866OtherGREAT WEST
CA1073243OtherFIRST HEALTH
CA1452522OtherUNITED HEALTHCARE
CA90026479OtherPACIFICARE
CAG33106OtherBLUE CROSS
CA00G331060Medicaid
CA500151OtherHEALTH NET
CA000810342866OtherPHCS
CA00G331060OtherBLUE SHIELD
CA500151OtherHEALTH NET