Provider Demographics
NPI:1972915403
Name:OSTROM, JONNAE Y (MD)
Entity Type:Individual
Prefix:
First Name:JONNAE
Middle Name:Y
Last Name:OSTROM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JONNAE
Other - Middle Name:
Other - Last Name:BARRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2121 N CRAYCROFT RD BLDG 5
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2801
Mailing Address - Country:US
Mailing Address - Phone:520-296-8500
Mailing Address - Fax:520-495-7533
Practice Address - Street 1:2121 N CRAYCROFT RD BLDG 5
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2801
Practice Address - Country:US
Practice Address - Phone:520-296-8500
Practice Address - Fax:520-495-7533
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ59889207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ006381Medicaid