Basic Information
| Provider Information | |||||||||
| NPI: | 1518156090 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JOHN M. DEACON, M.D., INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1878 | ||||||||
| Address2: | |||||||||
| City: | GOLETA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931161878 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056967921 | ||||||||
| FaxNumber: | 8059646946 | ||||||||
| Practice Location | |||||||||
| Address1: | 351 S PATTERSON AVE | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931112403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056967920 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2007 | ||||||||
| LastUpdateDate: | 11/16/2010 | ||||||||
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| AuthorizedOfficialLastName: | DEACON | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8059643838 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0005X | A66064 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | Undersea and Hyperbaric Medicine |
No ID Information.