Provider Demographics
NPI:1578512968
Name:TURNAGE, JIMMY WAYNE (MD, PSYD)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:WAYNE
Last Name:TURNAGE
Suffix:
Gender:M
Credentials:MD, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7930 FROST ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2737
Mailing Address - Country:US
Mailing Address - Phone:858-569-6800
Mailing Address - Fax:858-569-6807
Practice Address - Street 1:7930 FROST ST
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2737
Practice Address - Country:US
Practice Address - Phone:858-569-6800
Practice Address - Fax:858-569-6807
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG079173207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G791730Medicaid
CA00G791730Medicaid
CAWG79173EMedicare ID - Type Unspecified