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NPI Code Detail

MEDICARE: JONNAE Y OSTROM MD

MEDICARE: JONNAE Y OSTROM MD
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
1207YX0905XOtolaryngology/Facial Plastic Surgery Physician59889AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1972915403
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONNAE Y OSTROM MD
Provider Business Mailing Address
First Line : 2121 N CRAYCROFT RD BLDG 5
Second Line :
City : TUCSON
State : AZ
Zip : 85712-2801
Country : US
Telephone Number : 520-296-8500
Fax Number : 520-495-7533
Provider Business Practice Location Address
First Line : 2121 N CRAYCROFT RD BLDG 5
Second Line :
City : TUCSON
State : AZ
Zip : 85712-2801
Country : US
Telephone Number : 520-296-8500
Fax Number : 520-495-7533
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2014
Last Update Date : 08/07/2020

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Directions to “ JONNAE Y OSTROM MD” Practice Location

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