Provider Demographics
NPI:1194822742
Name:SAWYER, JOHN DONALD III (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DONALD
Last Name:SAWYER
Suffix:III
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 LANGSDORF DR
Mailing Address - Street 2:# 219
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-3702
Mailing Address - Country:US
Mailing Address - Phone:714-871-9732
Mailing Address - Fax:714-871-4561
Practice Address - Street 1:680 LANGSDORF DR
Practice Address - Street 2:# 219
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-3702
Practice Address - Country:US
Practice Address - Phone:714-871-9732
Practice Address - Fax:714-871-4561
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11021103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CP11021Medicare ID - Type Unspecified