Provider Demographics
NPI:1477602068
Name:CHON, JOANNA K (MD)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:K
Last Name:CHON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:3291 WOODS EDGE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-1301
Practice Address - Country:US
Practice Address - Phone:239-434-8565
Practice Address - Fax:239-434-8569
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2016-04-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD073541L208800000X
CAA71494208800000X
FLME112716208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018649820003Medicaid
PA001864982003Medicaid
FL14KT9OtherBCBS FL
FL355415OtherAVMED
FL005458100Medicaid
FL1641161OtherCIGNA
FLP959329OtherOPTIMUM
FL0054581-00Medicaid
FL1192969OtherWELLCARE
FL7326257OtherAETNA
FLP01054248OtherRAILROAD MEDICARE
FLP1003924OtherFREEDOM
FL005458100Medicaid
PA050886H8LMedicare PIN
FL7326257OtherAETNA
050886 HBLMedicare UPIN
PA0018649820003Medicaid