Provider Demographics
NPI:1760686794
Name:BEZEMER, JOHN DARWIN (LPT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DARWIN
Last Name:BEZEMER
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:21951 EMERY LN
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:CA
Mailing Address - Zip Code:95713-9513
Mailing Address - Country:US
Mailing Address - Phone:916-780-3298
Mailing Address - Fax:916-780-3281
Practice Address - Street 1:11512 B AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-2605
Practice Address - Country:US
Practice Address - Phone:916-780-3298
Practice Address - Fax:916-780-3281
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CALI20185167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician