Basic Information
| Provider Information | |||||||||
| NPI: | 1720049620 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FOLEY | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | V | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2349 | ||||||||
| Address2: | |||||||||
| City: | TRUCKEE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 961602349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5305355065 | ||||||||
| FaxNumber: | 5305365069 | ||||||||
| Practice Location | |||||||||
| Address1: | 10956 DONNER PASS RD | ||||||||
| Address2: | SUITE310 | ||||||||
| City: | TRUCKEE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 961614861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5305365065 | ||||||||
| FaxNumber: | 5305365069 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2006 | ||||||||
| LastUpdateDate: | 05/20/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | G76285 | CA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | NV7929 | NV | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 00G762850 | 01 | CA | MEDI-CAL | OTHER | 200044843 | 01 | RAILROAD MEDICARE | OTHER | 00G762850 | 05 | CA | MEDICAID |