Provider Demographics
NPI:1225063464
Name:STURGEON, JOHN M III (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:STURGEON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 CITY POINT DR STE 200
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-8380
Mailing Address - Country:US
Mailing Address - Phone:817-255-1940
Mailing Address - Fax:469-713-8379
Practice Address - Street 1:4300 CITY POINT DR STE 200
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-8380
Practice Address - Country:US
Practice Address - Phone:817-255-1940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9911207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX155964302Medicaid
TX155964303Medicaid
8F9806OtherMEDICARE PTAN
TX155964303Medicaid