Provider Demographics
NPI:1568469583
Name:MCNERNEY, JOHN J JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:MCNERNEY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 N SWAN RD
Mailing Address - Street 2:SUITE B.
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-1225
Mailing Address - Country:US
Mailing Address - Phone:520-327-3454
Mailing Address - Fax:520-327-3431
Practice Address - Street 1:3040 N SWAN RD
Practice Address - Street 2:SUITE B.
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1225
Practice Address - Country:US
Practice Address - Phone:520-327-3454
Practice Address - Fax:520-327-3431
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17464174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZWMBKD06Medicare ID - Type Unspecified
AZE90068Medicare UPIN