Provider Demographics
NPI:1073598330
Name:ULOTH, JON SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:SCOTT
Last Name:ULOTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1510
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47706-1510
Mailing Address - Country:US
Mailing Address - Phone:812-435-0977
Mailing Address - Fax:812-450-6288
Practice Address - Street 1:3711 CASEY RD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-8343
Practice Address - Country:US
Practice Address - Phone:812-490-1122
Practice Address - Fax:812-490-1123
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY51751207Q00000X
IN01041620207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100331740AMedicaid
IN100331740AMedicaid
IN177540CMedicare ID - Type Unspecified