Provider Demographics
NPI:1386833945
Name:DAVID SIZEMORE JR MD A PROFESSIONAL
Entity Type:Organization
Organization Name:DAVID SIZEMORE JR MD A PROFESSIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALDEN
Authorized Official - Last Name:SIZEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-929-2300
Mailing Address - Street 1:1030 SAINT JOHN PL
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4422
Mailing Address - Country:US
Mailing Address - Phone:951-929-2300
Mailing Address - Fax:951-929-0584
Practice Address - Street 1:1030 SAINT JOHN PL
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4422
Practice Address - Country:US
Practice Address - Phone:951-929-2300
Practice Address - Fax:951-929-0584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG041592208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ32029ZOtherMEDICARE CORPORATION NUMB