Provider Demographics
NPI:1477567923
Name:DEACON, JOHN MARK (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MARK
Last Name:DEACON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1878
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93116-1878
Mailing Address - Country:US
Mailing Address - Phone:805-696-7920
Mailing Address - Fax:805-696-7921
Practice Address - Street 1:351 S PATTERSON AVE
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-2403
Practice Address - Country:US
Practice Address - Phone:805-696-7920
Practice Address - Fax:805-696-7921
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA66064207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A660640Medicaid
CA00A660640Medicaid
CAWA66064AMedicare PIN