Provider Demographics
NPI:1164507166
Name:STURGES, JOHN A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:STURGES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:A
Other - Last Name:STURGES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2170 W IRONWOOD CENTER DR STE A
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2606
Mailing Address - Country:US
Mailing Address - Phone:208-665-5596
Mailing Address - Fax:208-665-9842
Practice Address - Street 1:2170 W IRONWOOD CENTER DR STE A
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2606
Practice Address - Country:US
Practice Address - Phone:208-665-5596
Practice Address - Fax:208-665-9842
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM6585204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID003941500Medicaid
ID1130576Medicare PIN
ID003941500Medicaid
ID1374102Medicare PIN