Provider Demographics
NPI:1760440101
Name:PARSONS, JOHN KELLOGG (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KELLOGG
Last Name:PARSONS
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:PO BOX 232410
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92193-2410
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3855 HEALTH SCIENCES DRIVE #0987
Practice Address - Street 2:MOORES UCSD COMPREHENSIVE CANCER CENTER
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92093-0987
Practice Address - Country:US
Practice Address - Phone:858-822-6187
Practice Address - Fax:858-822-6188
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91156208600000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A911560Medicaid
CAH74240Medicare UPIN
CA00A911560Medicaid