Provider Demographics
NPI:1467438572
Name:NESTOR, JOHN P (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:NESTOR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1625
Mailing Address - Street 2:
Mailing Address - City:PAGE
Mailing Address - State:AZ
Mailing Address - Zip Code:86040-1625
Mailing Address - Country:US
Mailing Address - Phone:928-645-9675
Mailing Address - Fax:928-645-2626
Practice Address - Street 1:2016 W 16TH ST
Practice Address - Street 2:SAFFORD COMMUNITY HEALTH CENTER
Practice Address - City:SAFFORD
Practice Address - State:AZ
Practice Address - Zip Code:85546-4026
Practice Address - Country:US
Practice Address - Phone:928-428-1500
Practice Address - Fax:928-428-1555
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2011-09-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ3915207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ788711Medicare UPIN
H86037Medicare UPIN
103673Medicare ID - Type Unspecified