Provider Demographics
NPI:1134128523
Name:IZBICKI, JONATHON A (DO)
Entity Type:Individual
Prefix:DR
First Name:JONATHON
Middle Name:A
Last Name:IZBICKI
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Gender:M
Credentials:DO
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Mailing Address - Street 1:717 STATE STREET, SUITE 16, LL
Mailing Address - Street 2:IZBICKI FAMILY MEDICINE, PC
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508
Mailing Address - Country:US
Mailing Address - Phone:814-877-7100
Mailing Address - Fax:814-877-2939
Practice Address - Street 1:3424 PEACH ST.
Practice Address - Street 2:IZBICKI FAMILY MEDICINE, PC
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508
Practice Address - Country:US
Practice Address - Phone:814-461-6626
Practice Address - Fax:814-871-6349
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2010-03-19
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Provider Licenses
StateLicense IDTaxonomies
PAPA 05013096207Q00000X
PAOS013096207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA136335Medicare UPIN