Provider Demographics
NPI:1336293992
Name:DIZON, JON E (MD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:E
Last Name:DIZON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4301 GARTH RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-3153
Mailing Address - Country:US
Mailing Address - Phone:281-428-7278
Mailing Address - Fax:281-422-2504
Practice Address - Street 1:4301 GARTH RD
Practice Address - Street 2:SUITE 302
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3153
Practice Address - Country:US
Practice Address - Phone:281-428-7278
Practice Address - Fax:281-422-2504
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXF8745208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF42357Medicare UPIN