Provider Demographics
NPI:1275554867
Name:PRITCHETT, JON R (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:R
Last Name:PRITCHETT
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:360 SIERRA COLLEGE DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5088
Mailing Address - Country:US
Mailing Address - Phone:530-477-7390
Mailing Address - Fax:530-477-7389
Practice Address - Street 1:360 SIERRA COLLEGE DR
Practice Address - Street 2:SUITE 120
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5088
Practice Address - Country:US
Practice Address - Phone:530-477-7390
Practice Address - Fax:530-477-7389
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2015-04-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA80293207Q00000X
IL036111453207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1275554867Medicaid
CACA130126Medicare PIN
IL036111453Medicaid