Provider Demographics
NPI:1891886362
Name:WOMACH, JOHN O (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:O
Last Name:WOMACH
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 1:1995 ZINFANDEL DR STE 204
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-2862
Mailing Address - Country:US
Mailing Address - Phone:916-638-1995
Mailing Address - Fax:916-638-2514
Practice Address - Street 1:1995 ZINFANDEL DR STE 204
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-2862
Practice Address - Country:US
Practice Address - Phone:916-638-1995
Practice Address - Fax:916-638-2514
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG24835207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G248350Medicare ID - Type Unspecified
A42415Medicare UPIN