Provider Demographics
NPI:1588826663
Name:JOHN A. STURGES, MD PA
Entity Type:Organization
Organization Name:JOHN A. STURGES, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:STURGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-665-5596
Mailing Address - Street 1:PO BOX 2763
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-2763
Mailing Address - Country:US
Mailing Address - Phone:208-665-5596
Mailing Address - Fax:208-665-9842
Practice Address - Street 1:2170 W IRONWOOD CENTER DR
Practice Address - Street 2:SUITE A
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2606
Practice Address - Country:US
Practice Address - Phone:208-665-5596
Practice Address - Fax:208-665-9842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-6585207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1374102Medicare PIN