Healthcare Provider Details

I. General information

NPI: 1629139829
Provider Name (Legal Business Name): JOHN D. AMMON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 PETERSBURG RD
BURLINGTON KY
41005-8786
US

IV. Provider business mailing address

3901 PETERSBURG RD
BURLINGTON KY
41005-8786
US

V. Phone/Fax

Practice location:
  • Phone: 859-689-4791
  • Fax:
Mailing address:
  • Phone: 859-689-4791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13871
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35029763A
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number36019
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3676
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: