Provider Demographics
NPI:1053829465
Name:JOHN PADOUR MD A MEDICAL CORP
Entity Type:Organization
Organization Name:JOHN PADOUR MD A MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:REPLOGLE
Authorized Official - Suffix:
Authorized Official - Credentials:CMA
Authorized Official - Phone:805-641-1800
Mailing Address - Street 1:148 N BRENT ST STE 201
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2818
Mailing Address - Country:US
Mailing Address - Phone:805-641-1800
Mailing Address - Fax:805-653-7468
Practice Address - Street 1:148 N BRENT ST.
Practice Address - Street 2:SUITE 201
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-9300
Practice Address - Country:US
Practice Address - Phone:805-641-1800
Practice Address - Fax:805-653-7468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-19
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA364934207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA36934Medicaid