Provider Demographics
NPI:1154681401
Name:SISSNEY, JOHN B (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:B
Last Name:SISSNEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5012 S US HIGHWAY 75 STE 300
Mailing Address - Street 2:ATTN BILLING
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-4589
Mailing Address - Country:US
Mailing Address - Phone:903-416-6025
Mailing Address - Fax:
Practice Address - Street 1:5012 S US HIGHWAY 75 STE 300
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-4589
Practice Address - Country:US
Practice Address - Phone:903-416-6025
Practice Address - Fax:903-416-6138
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP9003207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX342527403Medicaid
OK200591050AMedicaid
TX342527403Medicaid