Provider Demographics
NPI:1205403482
Name:JOHN MUIR PHYSICIAN NETWORK
Entity Type:Organization
Organization Name:JOHN MUIR PHYSICIAN NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR AMBULATORY CARE
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JAGOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-952-2706
Mailing Address - Street 1:1450 TREAT BLVD # 300
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-2168
Mailing Address - Country:US
Mailing Address - Phone:925-952-2855
Mailing Address - Fax:
Practice Address - Street 1:400 TAYLOR BLVD
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-2147
Practice Address - Country:US
Practice Address - Phone:925-677-5041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy