Provider Demographics
NPI:1598804346
Name:CANIO, JOHN B (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:B
Last Name:CANIO
Suffix:
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 1:4 MEDICAL PLAZA DR STE 205
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-2815
Mailing Address - Country:US
Mailing Address - Phone:916-773-6200
Mailing Address - Fax:916-782-4550
Practice Address - Street 1:4 MEDICAL PLAZA DR STE 205
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2815
Practice Address - Country:US
Practice Address - Phone:916-773-6200
Practice Address - Fax:916-782-4550
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT117660207RG0100X
CAA54545207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ13842ZOtherMEDICARE ID - ROSEVILLE
CAZZZ29516ZOtherMEDICARE ID - LINCOLN
CAZZZ13842ZOtherMEDICARE ID - CARMICHAEL
CAZZZ43589ZOtherMEDICARE SUBMITTER ID
CAA54545OtherCA MEDICAL LICENSE
CAZZZ13842ZOtherMEDICARE ID - ROSEVILLE
CAZZZ13842ZOtherMEDICARE ID - CARMICHAEL