Provider Demographics
NPI:1043248719
Name:STRONG, JOHN MARSHALL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MARSHALL
Last Name:STRONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1420 OCOTILLO DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-4213
Mailing Address - Country:US
Mailing Address - Phone:760-352-2551
Mailing Address - Fax:760-352-3022
Practice Address - Street 1:1420 OCOTILLO DR
Practice Address - Street 2:SUITE B
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-4213
Practice Address - Country:US
Practice Address - Phone:760-352-2551
Practice Address - Fax:760-352-3022
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG85954207KA0200X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G859540Medicaid
CA00G859540Medicaid
CAG85954Medicare ID - Type Unspecified