Healthcare Provider Details

I. General information

NPI: 1255699278
Provider Name (Legal Business Name): JONATHON MICHAEL FIELDS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2012
Last Update Date: 08/15/2021
Certification Date: 08/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 9TH ST SE STE 1
ROCHESTER MN
55904-6400
US

IV. Provider business mailing address

1266 265TH ST
JANESVILLE IA
50647-9759
US

V. Phone/Fax

Practice location:
  • Phone: 507-292-7144
  • Fax: 507-292-7069
Mailing address:
  • Phone: 507-261-0556
  • Fax: 319-575-6029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number41199
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number63255
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR-9371
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: