Provider Demographics
NPI:1326126004
Name:MONESS, JON M (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:M
Last Name:MONESS
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 1:3860 EL DORADO HILLS BLVD
Mailing Address - Street 2:SUIT # 601
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-4563
Mailing Address - Country:US
Mailing Address - Phone:916-678-5292
Mailing Address - Fax:
Practice Address - Street 1:3860 EL DORADO HILLS BLVD
Practice Address - Street 2:SUIT # 601
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-5507
Practice Address - Country:US
Practice Address - Phone:916-678-5292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53163207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A531630Medicaid
00A531630Medicare ID - Type Unspecified
CA00A531630Medicaid