MEDICARE: DR. JONATHAN E EFRON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208C00000X	Colon & Rectal Surgery Physician	33553	AZ
2	208600000X	Surgery Physician	D69531	MD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00217762	OTHER	AZ	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	86080015085259A982	OTHER	AZ	TRIWEST

General Provider Information

NPI Number	:	1538144647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN E EFRON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 64563
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21264-4563
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4940 EASTERN AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21224-2735
Country	:	US
Telephone Number	:	410-550-0100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2005
Last Update Date	:	02/10/2014

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Directions to “ DR. JONATHAN E EFRON M.D.” Practice Location

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