Provider Demographics
NPI:1326036062
Name:AHRENDSEN, JON S (MD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:S
Last Name:AHRENDSEN
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 271
Mailing Address - Street 2:215 13TH AVE SW
Mailing Address - City:CLARION
Mailing Address - State:IA
Mailing Address - Zip Code:50525-0271
Mailing Address - Country:US
Mailing Address - Phone:515-532-2836
Mailing Address - Fax:515-532-2523
Practice Address - Street 1:215 13TH AVE SW
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:IA
Practice Address - Zip Code:50525-2078
Practice Address - Country:US
Practice Address - Phone:515-532-2836
Practice Address - Fax:515-532-2523
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23659207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
6226449Medicare ID - Type Unspecified
A02356Medicare UPIN