Provider Demographics
NPI:1679598536
Name:CARREON, ADRIAN ENAD (MD)
Entity type:Individual
Prefix:DR
First Name:ADRIAN
Middle Name:ENAD
Last Name:CARREON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:410 E YOSEMITE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-8220
Mailing Address - Country:US
Mailing Address - Phone:209-384-9108
Mailing Address - Fax:209-384-0580
Practice Address - Street 1:3605 HOSPITAL RD
Practice Address - Street 2:SUITE F
Practice Address - City:ATWATER
Practice Address - State:CA
Practice Address - Zip Code:95301-5173
Practice Address - Country:US
Practice Address - Phone:209-381-0184
Practice Address - Fax:209-381-0190
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA54997207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A549970Medicaid
00A549970Medicare ID - Type Unspecified
CA00A549970Medicaid