Provider Demographics
NPI:1811222441
Name:JOHN A DANA M D PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:JOHN A DANA M D PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-906-0400
Mailing Address - Street 1:3480 BUSKIRK AVENUE
Mailing Address - Street 2:SUITE 145
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523
Mailing Address - Country:US
Mailing Address - Phone:925-906-0400
Mailing Address - Fax:
Practice Address - Street 1:3480 BUSKIRK AVENUE
Practice Address - Street 2:SUITE 145
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523
Practice Address - Country:US
Practice Address - Phone:925-906-0400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG76791208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty