Provider Demographics
NPI:1609879683
Name:NORTON, JONATHAN VN (DPM)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:VN
Last Name:NORTON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8028 CARNEGIE BLVD STE 400
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804
Practice Address - Country:US
Practice Address - Phone:260-747-5572
Practice Address - Fax:260-747-8392
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000881A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN251000AMedicare PIN
IN251000Medicare PIN
INDG4243Medicare PIN
INU72076Medicare UPIN
IN251000AMedicare PIN
IN200362710Medicaid
IN200847960Medicaid
IN0110200812Medicare NSC
IN5887650002Medicare NSC
IN5887650001Medicare NSC
IN0621200712Medicare NSC
IN251000Medicare PIN
IN200847960AMedicaid