Provider Demographics
NPI:1790790475
Name:ANNABLE, JOHN W (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:ANNABLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:20911 EARL ST
Mailing Address - Street 2:STE 440
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4352
Mailing Address - Country:US
Mailing Address - Phone:310-542-0455
Mailing Address - Fax:310-542-1303
Practice Address - Street 1:20911 EARL ST
Practice Address - Street 2:STE 440
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4352
Practice Address - Country:US
Practice Address - Phone:310-542-0455
Practice Address - Fax:310-542-1303
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2021-09-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAC30935207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C309350Medicaid
CAA34410Medicare UPIN
CAWC30935PMedicare ID - Type UnspecifiedMEDICARE PPIN