Provider Demographics
NPI:1902971013
Name:MEVI, JOHN FLAVIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FLAVIAN
Last Name:MEVI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:400 WEST I STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:LOS BANOS
Mailing Address - State:CA
Mailing Address - Zip Code:93635
Mailing Address - Country:US
Mailing Address - Phone:209-826-3200
Mailing Address - Fax:209-826-1354
Practice Address - Street 1:400 WEST I STREET
Practice Address - Street 2:SUITE A
Practice Address - City:LOS BANOS
Practice Address - State:CA
Practice Address - Zip Code:93635
Practice Address - Country:US
Practice Address - Phone:209-826-3200
Practice Address - Fax:209-826-1354
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA19847207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A198470Medicaid
CA00A198470Medicaid
CAA21918Medicare UPIN