Jerry William San Diego, M.D.

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

024399 Issued in LA

Practice address

4101 S 4TH St
P and LMS
Leavenworth, KS 66048-5014

Phone

(913) 682-2000

Fax

(913) 758-4193

NPI assigned

Mar 28, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407110400000",
    "number": "1285694604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4101 S 4TH ST",
            "address_2": "P AND LMS",
            "city": "LEAVENWORTH",
            "state": "KS",
            "postal_code": "660485014",
            "telephone_number": "913-682-2000",
            "fax_number": "913-758-4193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4101 S 4TH ST",
            "address_2": "P AND LMS",
            "city": "LEAVENWORTH",
            "state": "KS",
            "postal_code": "660485014",
            "telephone_number": "913-682-2000",
            "fax_number": "913-758-4193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAN DIEGO",
        "first_name": "JERRY",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-28",
        "last_updated": "2014-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "LA",
            "license": "024399",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Saint Lukes Hospice of Leavenworth LLC
• Saint Lukes Northland Hospital Corporation
• Saint Matthew'S Healthcare LLC
• Muhammad A Salamat, MD
• Mary Sams
• Ashlynne Sanchez
• Jason Thomas Sander, PHARMD
• April Sanders, LPC, LSOTP
• Carl Sanders
• James Edward Sanders, MD

• Anatomic Pathology & Clinical Pathology Physician in Leavenworth, KS
• Providers in Leavenworth, KS by specialty
• Anatomic Pathology & Clinical Pathology Physician in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.