Provider Demographics
NPI:1518925882
Name:TOMASSON, JON (MD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:
Last Name:TOMASSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14700 28TH AVE N
Mailing Address - Street 2:SUITE 20
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-4835
Mailing Address - Country:US
Mailing Address - Phone:763-559-3779
Mailing Address - Fax:763-559-3543
Practice Address - Street 1:14700 28TH AVE N
Practice Address - Street 2:SUITE 20
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-4835
Practice Address - Country:US
Practice Address - Phone:763-559-3779
Practice Address - Fax:763-559-3543
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI45049207L00000X
OH35.089468207LC0200X, 207L00000X, 207LP3000X
MN52894207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine