Provider Demographics
NPI:1659332682
Name:TONTZ, WILLIAM LOGAN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LOGAN
Last Name:TONTZ
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 40TH ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-1724
Mailing Address - Country:US
Mailing Address - Phone:941-205-0201
Mailing Address - Fax:
Practice Address - Street 1:802 40TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-1724
Practice Address - Country:US
Practice Address - Phone:941-205-0201
Practice Address - Fax:941-210-6300
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69746207XS0117X
IL036126512207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003738300Medicaid
CA00A697460Medicaid
IL209658006OtherMEDICARE PTAN
FLFG887ZMedicare PIN
I16928Medicare UPIN
CAWA69746AMedicare ID - Type Unspecified