Provider Demographics
NPI:1841283132
Name:DEJONG, JOHN THEODORE (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:THEODORE
Last Name:DEJONG
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 1:5147 N 9TH AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8771
Mailing Address - Country:US
Mailing Address - Phone:850-479-7229
Mailing Address - Fax:850-479-7250
Practice Address - Street 1:5147 N 9TH AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8771
Practice Address - Country:US
Practice Address - Phone:850-479-7229
Practice Address - Fax:850-479-7250
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0053867207X00000X
TXL1829207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G40603Medicare UPIN