Provider Demographics
NPI:1629055389
Name:ZOLTAN, JON D (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:D
Last Name:ZOLTAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2222 E HIGHLAND AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4872
Mailing Address - Country:US
Mailing Address - Phone:602-277-6211
Mailing Address - Fax:866-242-5309
Practice Address - Street 1:2222 E HIGHLAND AVE
Practice Address - Street 2:STE 300
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4872
Practice Address - Country:US
Practice Address - Phone:602-277-6211
Practice Address - Fax:866-242-5309
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2010-07-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ9893207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ219594Medicaid
ZWCJCV11Medicare PIN
D00622Medicare UPIN