Provider Demographics
NPI:1902871585
Name:MEDLEN, JOHN C (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:MEDLEN
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:1701 W ST MARY'S RD
Mailing Address - Street 2:SUITE 145
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-2683
Mailing Address - Country:US
Mailing Address - Phone:520-624-0888
Mailing Address - Fax:520-624-0091
Practice Address - Street 1:1701 W ST MARY'S RD
Practice Address - Street 2:SUITE 145
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2683
Practice Address - Country:US
Practice Address - Phone:520-624-0888
Practice Address - Fax:520-624-0091
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2010-03-04
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Provider Licenses
StateLicense IDTaxonomies
AZ12924207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ236069Medicaid
C99968Medicare UPIN