Healthcare Provider Details

I. General information

NPI: 1609879683
Provider Name (Legal Business Name): JONATHAN VN NORTON D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 11/21/2022
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8028 CARNEGIE BLVD STE 400
FORT WAYNE IN
46804
US

IV. Provider business mailing address

11109 PARKVIEW PLAZA DR # 117
FORT WAYNE IN
46845-1701
US

V. Phone/Fax

Practice location:
  • Phone: 260-747-5572
  • Fax: 260-747-8392
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number07000881A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: