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General NPI Number Information
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NPI Number | 1871544817
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Entity Type | Individual
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Provider Name | JON H. WALZ JR. D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/15/2006
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Last Update Date | 06/12/2019
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Provider Practice Location Address
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Address Line | 1000 ASHLAND DR SUITE 105
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City | ASHLAND
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State | KY
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Zip | 41101-7057
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Country | US
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Telephone | 606-327-0077
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Fax | 606-833-9453
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Provider Business Mailing Address
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Address Line | 105 PONDER CT STE 104
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City | DANVILLE
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State | KY
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Zip | 40422-9050
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Country | US
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Telephone | 606-327-0077
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Fax | 606-833-9453
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 02629
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License Number State | KY
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