Provider Demographics
NPI:1972569499
Name:MISSIRIAN, JOHN O (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:O
Last Name:MISSIRIAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1800 SULLIVAN AVE
Mailing Address - Street 2:STE 402 THE ORTHOPAEDIC GROUP OF SF INC
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2224
Mailing Address - Country:US
Mailing Address - Phone:650-992-7700
Mailing Address - Fax:650-756-6254
Practice Address - Street 1:1800 SULLIVAN AVE
Practice Address - Street 2:STE 402 THE ORTHOPAEDIC GROUP OF SF INC
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2224
Practice Address - Country:US
Practice Address - Phone:650-992-7700
Practice Address - Fax:650-756-6254
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2009-12-14
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA36762207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35OH1222OtherOHIO LICENSE
CAOOC378150Medicaid
A36762Medicare UPIN
ZZZ76286ZMedicare ID - Type Unspecified
CAZZZ76285ZMedicare ID - Type Unspecified