Healthcare Provider Details

I. General information

NPI: 1437414711
Provider Name (Legal Business Name): JONATHAN WAYNE VONKOENIG D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2012
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2489 DIPLOMAT PKWY E
CAPE CORAL FL
33909-5422
US

IV. Provider business mailing address

11180 SPARKLEBERRY DR
FORT MYERS FL
33913-8832
US

V. Phone/Fax

Practice location:
  • Phone: 239-652-1800
  • Fax: 239-652-1930
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberOS14198
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: