Provider Demographics
NPI:1912975772
Name:AMAR, JOHN D (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:AMAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15247 ELEVENTH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-3727
Mailing Address - Country:US
Mailing Address - Phone:760-245-8645
Mailing Address - Fax:760-245-6798
Practice Address - Street 1:15247 ELEVENTH ST STE 200
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-3727
Practice Address - Country:US
Practice Address - Phone:760-245-8645
Practice Address - Fax:760-245-6798
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30230207YX0602X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA756041862OtherRAILROAD MEDICARE
CAZZZ37372OtherBLUE SHIELD GROUP
CA00A302300Medicaid
A26012Medicare UPIN