Provider Demographics
NPI:1245205137
Name:DESANTIS, JOHN GEORGE (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:GEORGE
Last Name:DESANTIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1730
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-1058
Mailing Address - Country:US
Mailing Address - Phone:760-568-2684
Mailing Address - Fax:760-341-5832
Practice Address - Street 1:39000 BOB HOPE DR
Practice Address - Street 2:HARRY & DIANE RINKER BUILDING
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3221
Practice Address - Country:US
Practice Address - Phone:760-568-2684
Practice Address - Fax:760-341-5832
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A 10304207X00000X
MI5101008049207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
4127171OtherAETNA
5440013OtherBLUE CARE NETWORK
2054400135OtherBCBS OF MICHIGAN
C2477OtherMCARE
D60760OtherHEALTH ALLIANCE PLAN/HAP
200036404OtherRAILROAD MEDICARE
2054400135OtherHEALTH PLUS
CA20A 10304OtherCA LICENSE
200036404OtherRAILROAD MEDICARE
200036404OtherRAILROAD MEDICARE
C2477OtherMCARE