Provider Demographics
NPI:1720097058
Name:DRESSER, JON LAUREN (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:LAUREN
Last Name:DRESSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5525 DEWEY DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-3129
Mailing Address - Country:US
Mailing Address - Phone:916-967-7285
Mailing Address - Fax:916-967-7289
Practice Address - Street 1:5525 DEWEY DR
Practice Address - Street 2:SUITE 204
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-3129
Practice Address - Country:US
Practice Address - Phone:916-967-7285
Practice Address - Fax:916-967-7289
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG27209207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA43267Medicare UPIN