NPIMap

Organization Active NPI

Idahosurgeons Net PC

  • Trauma Surgery Physician
  • San Diego, CA
National Provider Identifier
1295237022
Registry record updated Mar 22, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Trauma Surgery PhysicianTaxonomy code 2086S0127X
License
G151173 Issued in CA
Legal business name
IDAHOSURGEONS NET PC
Practice address
7910 Frost St Ste 250
San Diego, CA 92123-2752
Phone
(858) 565-0104
Fax
(844) 213-3678
NPI assigned
Mar 7, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2018

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

Authorized official

Name
John C. Mayberry, MD
Title
President
Phone
(858) 565-0104

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Trauma Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2086S0127X G151173 CA Primary

Addresses

Primary practice location

7910 Frost St Ste 250
San Diego, CA 92123-2752

Mailing address

7910 Frost St Ste 250
San Diego, CA 92123-2752
Phone (858) 565-0104

National Provider Directory

National Provider Directory

Locations

315 S Coast Hwy
#101
Encinitas, CA 92024

7930 Frost St
Ste 204
San Diego, CA 92123
Phone (858) 565-0104

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1520380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521676800000",
    "number": "1295237022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7910 FROST ST STE 250",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921232752",
            "telephone_number": "858-565-0104",
            "fax_number": "844-213-3678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7910 FROST ST STE 250",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921232752",
            "telephone_number": "858-565-0104",
            "fax_number": "844-213-3678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHOSURGEONS NET PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-07",
        "last_updated": "2018-03-22",
        "status": "A",
        "authorized_official_last_name": "MAYBERRY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "858-565-0104",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2086S0127X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Trauma Surgery",
            "state": "CA",
            "license": "G151173",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2018; 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.