Provider Demographics
NPI:1851377493
Name:SYKES, JONATHAN MARK (MD, FACS)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:MARK
Last Name:SYKES
Suffix:
Gender:M
Credentials:MD, FACS
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Mailing Address - Street 1:8975 CAMINO DEL AVION
Mailing Address - Street 2:
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-5858
Mailing Address - Country:US
Mailing Address - Phone:916-652-5417
Mailing Address - Fax:916-456-7509
Practice Address - Street 1:8975 CAMINO DEL AVION
Practice Address - Street 2:
Practice Address - City:GRANITE BAY
Practice Address - State:CA
Practice Address - Zip Code:95746-5858
Practice Address - Country:US
Practice Address - Phone:916-652-5417
Practice Address - Fax:916-456-7509
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2016-09-28
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Provider Licenses
StateLicense IDTaxonomies
CAG59454207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACO4342Medicare UPIN