Provider Demographics
NPI:1508881434
Name:JOHN, ALEXANDER B JR (CRNA)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:B
Last Name:JOHN
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7096
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95267-0096
Mailing Address - Country:US
Mailing Address - Phone:209-956-7725
Mailing Address - Fax:209-956-7733
Practice Address - Street 1:2755 HERNDON AVENUE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-6800
Practice Address - Country:US
Practice Address - Phone:559-324-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANA2969367500000X
KY1100896163W00000X
KY054599367500000X
IN99012653A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000301355OtherANTHEM
INP00250733OtherRAILROAD MEDICARE
IN200450490Medicaid
OH2442324Medicaid
IN000000336278OtherANTHEM
P00048890Medicare PIN
CAP01007838Medicare PIN
000000301355OtherANTHEM
0094498Medicare PIN
IN200450490Medicaid