Healthcare Provider Details

I. General information

NPI: 1306188206
Provider Name (Legal Business Name): JOHN LIGON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 07/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 ORLEANS ST RM 11379
BALTIMORE MD
21287
US

IV. Provider business mailing address

1935 MEDICAL DISTRICT DR
DALLAS TX
75235-7701
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-8751
  • Fax: 410-955-0028
Mailing address:
  • Phone: 214-456-2735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberD0080982
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: