Provider Demographics
NPI:1588649727
Name:OVERHOLT, JON DAVID (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:DAVID
Last Name:OVERHOLT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4614 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-5833
Mailing Address - Country:US
Mailing Address - Phone:916-966-7137
Mailing Address - Fax:916-863-2965
Practice Address - Street 1:7551 MADISON AVE
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-7449
Practice Address - Country:US
Practice Address - Phone:916-904-3000
Practice Address - Fax:916-863-2965
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-09
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAC36069207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine