Provider Demographics
NPI:1164670030
Name:GOZDANOVIC, JON ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:ALLEN
Last Name:GOZDANOVIC
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 1:224 W EXCHANGE ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44302-1704
Mailing Address - Country:US
Mailing Address - Phone:330-344-7040
Mailing Address - Fax:330-344-1714
Practice Address - Street 1:1 AKRON GENERAL AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44307-2432
Practice Address - Country:US
Practice Address - Phone:330-344-7040
Practice Address - Fax:330-344-1714
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPPROVAL LETTER PEND208600000X
FLME 116008207L00000X
OH35-093811207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208600000XAllopathic & Osteopathic PhysiciansSurgery