Provider Demographics
NPI:1255391520
Name:BEDNAR, JOHN ALLAN (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALLAN
Last Name:BEDNAR
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 1:25 WIMBLEDON DR.
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270
Mailing Address - Country:US
Mailing Address - Phone:760-324-5406
Mailing Address - Fax:760-321-6274
Practice Address - Street 1:25 WIMBLEDON DR.
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270
Practice Address - Country:US
Practice Address - Phone:760-324-5406
Practice Address - Fax:760-321-6274
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG16536207VG0400X
CAG-16536207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA39820Medicare UPIN