Provider Demographics
NPI:1013095769
Name:BISSELL, JOHN ALBERT (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ALBERT
Last Name:BISSELL
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 1:3027 KADEMA DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-6922
Mailing Address - Country:US
Mailing Address - Phone:916-995-9572
Mailing Address - Fax:916-359-1137
Practice Address - Street 1:3027 KADEMA DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95864-6922
Practice Address - Country:US
Practice Address - Phone:916-359-1137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG231522084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G231520Medicaid
00G231520Medicare ID - Type Unspecified
A41872Medicare UPIN