| Doctor Name: | VERGIL DUANE SISSON |
| NPI Number: | 1619904182 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | C27156 |
| Business Practice Address: | 330 N D St Ste 300 San Bernardino, CA - 924011522 |
| Business Phone Number: | 9098886602 |
| Business Fax Number: | 9098857494 |
| Mailing Address: | 330 N D St, Ste 300 SAN BERNARDINO |
| State: | CA |
| Postal Code: | 924011522 |
| Phone Number: | 9099159750 |
| Fax Number: | |
| NPI Enumeration Date: | 06/28/2006 |
| NPI Last Update Date: | 02/24/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | C27156 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |