JOHN A BOUTELLER (NPI# 1114969029) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114969029 |
| Entity Type | Individual |
| Full Name | JOHN A BOUTELLER |
| Credential | M.D. |
| Practice Address |
415 E Harding Way Suite D Stockton CA 95204-6118 |
| Practice Telephone | 2099445750 |
| Mailing Telephone | 2099445750 |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
G34049 | CA | Allopathic & Osteopathic Physicians |
| Street Address |
415 E HARDING WAY SUITE D |
| City | STOCKTON |
| State | CA |
| Zip Code | 95204-6118 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104827906 | Ronald C Allison | Specialist | 415 E Harding Way, #h, Stockton, CA 95204-6118 | 2005-08-03 |
| 1669755682 | Caroline D Andersen | Physician Assistant | 415 E Harding Way, Suite D, Stockton, CA 95204-6118 | 2011-09-26 |
| 1942589965 | Donna J Burke | Nurse Practitioner | 415 E Harding Way, Suite D, Stockton, CA 95204-6118 | 2011-08-08 |
| 1790080281 | Dr Thaker Md, A Professional Corporation | Obstetrics & Gynecology | 415 E Harding Way, Suite I, Stockton, CA 95204-6118 | 2011-01-14 |
| 1528362050 | Sutter Gould Medical Foundation | Clinic/Center | 415 E Harding Way, Suite E, Stockton, CA 95204-6118 | 2010-12-23 |
| 1700035334 | Masanobu Kamigaki | Internal Medicine | 415 E Harding Way, Suite D, Stockton, CA 95204-6118 | 2008-09-18 |
| 1659539153 | Ajay K Toppur Ramanakumar | Internal Medicine | 415 E Harding Way, Suite D, Stockton, CA 95204-6118 | 2008-05-30 |
| 1386657666 | Stockton Endoscopy Center LLC | Clinic/Center | 415 E Harding Way, Suite E, Stockton, CA 95204 | 2006-08-15 |
| 1346276359 | Dean Karnaze | Specialist | 415 E Harding Way, Ste F, Stockton, CA 95204-6118 | 2006-06-23 |
| 1790720688 | Ronald Floyd Dugger | Specialist | 415 E Harding Way, Ste F, Stockton, CA 95204-6118 | 2006-06-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962027524 | Kariem Abdelwahed | Licensed Vocational Nurse | 1630 N. Edison St Stockton Ca, Stockton, CA 95204 | 2020-06-10 |
| 1831730555 | Ronnie C Murray | Counselor | 1947 North California Street, Stockton, CA 95204 | 2019-10-03 |
| 1235614116 | Michelle Ann Horn | Marriage & Family Therapist | 3666 Mission Rd, Stockton, CA 95204 | 2018-09-26 |
| 1356830947 | Stockton Pace | PACE Provider Organization | 582 E. Harding Way, Stockton, CA 95204 | 2018-05-09 |
| 1790228781 | Rebecca Phongsa | Counselor | 1947 North Calfornia Street, Suite B, Stockton, CA 95204 | 2016-11-23 |
| 1700332905 | Serim Kang | Driver | 4222 N Pershing Ave, Suite D2, Stockton, CA 95204 | 2016-08-28 |
| 1033565544 | Philip John Brereton | Orthotist | 466 E Harding Way, Stockton, CA 95204 | 2016-05-13 |
| 1932507522 | David Grayson | Counselor | 1621 Brookside Rd, Stockton, CA 95204 | 2014-12-12 |
| 1174934897 | Gurtej Malhi | Internal Medicine | 1901 N California Street, Stockton, CA 95204 | 2014-05-15 |
| 1396156170 | Rajesh Saini | Nurse Practitioner | 1805 N California St. Suite 102, Stockton, CA 95204 | 2014-05-14 |
| Find all providers in zip 95204 | ||||
| Taxonomy Code | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376665703 | M. Thabet Karabala, M.d., Inc. | Internal Medicine | 940 N Center St Ste A, Stockton, CA 95202-1326 | 2007-04-05 |
| 1649208463 | Pacific Heart and Vascular Medical Group | Internal Medicine | 1801 E March Lane, Suite D400, Stockton, CA 95210-5667 | 2006-06-29 |
| 1609826288 | M Thabet Karabala | Internal Medicine | 940 N Center St, Ste A, Stockton, CA 95202-1326 | 2006-05-12 |
| 1538783519 | Brooke Nicole Fletcher | Internal Medicine | 2633 Pacific Ave, Stockton, CA 95204-4429 | 2020-06-04 |
| 1962715987 | Muhammad W Choudhry | Internal Medicine | 2333 N California St, Stockton, CA 95204-5530 | 2010-07-19 |
| 1114157484 | Manreet Basra | Internal Medicine | 1801 E March Ln Ste D400, Stockton, CA 95210-6675 | 2009-07-21 |
| 1700035334 | Masanobu Kamigaki | Internal Medicine | 415 E Harding Way, Suite D, Stockton, CA 95204-6118 | 2008-09-18 |
| 1013030006 | Delta Heart & Medical Clinic, Inc. | Internal Medicine | 1801 E March Ln, A-170, Stockton, CA 95210-6629 | 2007-04-06 |
| 1093832636 | Amit Parekh | Internal Medicine | 7373 West Lane, Stockton, CA 95210 | 2007-03-26 |
| 1255481057 | Salma A. Baber | Internal Medicine | 7373 West Ln, Stockton, CA 95210-3377 | 2007-01-12 |
| Find all providers in STOCKTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.