Provider Demographics
NPI:1750302402
Name:AMON, JOHN BROCK (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:BROCK
Last Name:AMON
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 1:2911 SOUTH 8TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8000
Mailing Address - Country:US
Mailing Address - Phone:928-783-3050
Mailing Address - Fax:928-783-7783
Practice Address - Street 1:2911 SOUTH 8TH AVENUE
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8000
Practice Address - Country:US
Practice Address - Phone:928-783-3050
Practice Address - Fax:928-783-7783
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32952207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0095399401Medicaid
AZ953994Medicaid
ZWMBKJOtherMEDICARE GROUP #
AZI35345Medicare UPIN
AZ0095399401Medicaid