Provider Demographics
NPI:1871517953
Name:PLOSAY, JOHN J III (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:PLOSAY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1322 ANNANDALE TER
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2262
Mailing Address - Country:US
Mailing Address - Phone:626-403-0071
Mailing Address - Fax:626-403-0074
Practice Address - Street 1:1700 E WALNUT AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-2605
Practice Address - Country:US
Practice Address - Phone:800-882-9212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD428836207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD38252Medicare UPIN