Provider Demographics
NPI:1932401239
Name:JSHEARD MD INCORPORATED
Entity Type:Organization
Organization Name:JSHEARD MD INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:HEARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-595-9771
Mailing Address - Street 1:3628 E IMPERIAL HWY
Mailing Address - Street 2:STE 401
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-2643
Mailing Address - Country:US
Mailing Address - Phone:562-595-9771
Mailing Address - Fax:562-590-3175
Practice Address - Street 1:4025 CAMINO DEL RIO S
Practice Address - Street 2:STE 250
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4107
Practice Address - Country:US
Practice Address - Phone:619-285-5990
Practice Address - Fax:619-285-5988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-19
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG599612086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Single Specialty