Provider Demographics
NPI:1851311492
Name:DEROUEN, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:DEROUEN
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 1:3200 21ST ST STE 301
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-3108
Mailing Address - Country:US
Mailing Address - Phone:661-334-1958
Mailing Address - Fax:661-324-4095
Practice Address - Street 1:420 34TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-2237
Practice Address - Country:US
Practice Address - Phone:661-327-1792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG76575207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G765750Medicaid
CA050088508Medicare PIN
CACB232923Medicare PIN
CACD4582Medicare PIN
CA00G765753Medicare PIN
CA00G765754Medicare PIN
CA00G765755Medicare PIN
CA00G765756Medicare PIN
CAZZZ15998ZMedicare PIN
CAZZZ34009ZMedicare PIN
CAZZZ21367ZMedicare PIN
CA00G765752Medicare PIN
CA00G765750Medicaid
CAZZZ15999ZMedicare PIN
CAZZZ21366ZMedicare PIN
CA00G765751Medicare PIN
CAZZZ21365ZMedicare PIN