Provider Demographics
NPI:1720008972
Name:SCHWARTZ, JON (MD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:
Last Name:SCHWARTZ
Suffix:
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 1:3931 STOCKTON HILL RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-3001
Mailing Address - Country:US
Mailing Address - Phone:928-681-6100
Mailing Address - Fax:928-681-6103
Practice Address - Street 1:3931 STOCKTON HILL RD
Practice Address - Street 2:SUITE C
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-3001
Practice Address - Country:US
Practice Address - Phone:928-681-6100
Practice Address - Fax:928-681-6103
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2010-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28211207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ525404Medicaid
AZZ73008Medicare PIN
AZ525404Medicaid