Provider Demographics
NPI:1891842761
Name:RUMOHR, JON ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:ANDREW
Last Name:RUMOHR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:77 W FOREST AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1479
Mailing Address - Country:US
Mailing Address - Phone:928-773-2438
Mailing Address - Fax:928-773-2599
Practice Address - Street 1:77 W FOREST AVE STE 201
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1483
Practice Address - Country:US
Practice Address - Phone:928-773-2222
Practice Address - Fax:928-773-2599
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ49436208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1891842761OtherAFMC
AZ1891842761OtherBCBS
AZ1891842761OtherCIGNA
AZ1891842761OtherAETNA
AZ1891842761OtherHUMANA
AZ1891842761OtherUHC
AZ950808Medicaid
AZ1891842761OtherBCBS
AZ1891842761OtherAETNA