Provider Demographics
NPI:1649255449
Name:JONDLE, DANIEL M (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:M
Last Name:JONDLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3260 N HAYDEN RD STE 112
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6650
Mailing Address - Country:US
Mailing Address - Phone:602-687-7468
Mailing Address - Fax:602-264-9101
Practice Address - Street 1:1300 N 12TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2848
Practice Address - Country:US
Practice Address - Phone:602-687-7468
Practice Address - Fax:602-687-7683
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94604207ZP0102X
OH86942207ZP0102X
CODR42367207ZP0102X
AZ35979207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ317047OtherGROUP MEDICAID NUMBER
AZ120390OtherGROUP MEDICARE NUMBER
AZ317047OtherGROUP MEDICAID NUMBER