Provider Demographics
NPI:1255333480
Name:CRUES, JOHN VERNON (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:VERNON
Last Name:CRUES
Suffix:
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 1:1516 COTNER AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025
Mailing Address - Country:US
Mailing Address - Phone:310-445-2951
Mailing Address - Fax:310-479-1459
Practice Address - Street 1:1516 COTNER AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-3303
Practice Address - Country:US
Practice Address - Phone:310-445-2951
Practice Address - Fax:310-479-1459
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG421052085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0106039Medicaid
CA00G421050Medicaid
CAWG42105TMedicare PIN
CAWG42105VMedicare PIN
CAE81953Medicare UPIN
CA00G421054Medicare PIN
CA00G421058Medicare PIN
CA00G421057Medicare PIN
CAWG42105EEMedicare PIN
CA00G4210510Medicare PIN
CA00G421053Medicare PIN
CA00G421055Medicare PIN
CAWG42105FFMedicare PIN
CAWG42105IIMedicare PIN
CA00G4210511Medicare PIN
AR00G421056Medicare PIN
CAWG42105RMedicare PIN
CA00G421050Medicaid
CAAO767XMedicare PIN
CAE81953ZMedicare PIN
ARWG42105BBMedicare PIN
CAWG42105CCMedicare PIN
CAWG42105HHMedicare PIN
CAWG42105MMedicare PIN
CA00G421052Medicare PIN
CA00G421059Medicare PIN
CAWG42105GGMedicare PIN