Provider Demographics
NPI:1023056983
Name:ALEXANDER, JOHN HOWARD (PA-C)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:HOWARD
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2290 SACRAMENTO ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-2929
Mailing Address - Country:US
Mailing Address - Phone:707-643-5785
Mailing Address - Fax:707-643-8810
Practice Address - Street 1:2290 SACRAMENTO ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-2929
Practice Address - Country:US
Practice Address - Phone:707-643-5785
Practice Address - Fax:707-643-8810
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14144363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0023150Medicaid
CAP87775Medicare UPIN
CA0PA141440Medicare ID - Type Unspecified