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1356332373

NPI Code Detail

MEDICARE: JON THOMAS UMLAUF MD

MEDICARE: JON THOMAS UMLAUF MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	25MA56685	NJ
2	207U00000X	Nuclear Medicine Physician	MD00046429	WA
3	2083A0100X	Aerospace Medicine Physician	25MA56685	NJ
4	208D00000X	General Practice Physician	25MA56685	NJ
5	207U00000X	Nuclear Medicine Physician	G89012	CA

General Provider Information

NPI Number	:	1356332373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JON THOMAS UMLAUF MD

Provider Business Mailing Address
First Line	:	4647 ZION AVE
Second Line	:	NUCLEAR MEDICINE DEPARTMENT
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-2507
Country	:	US
Telephone Number	:	619-528-6567
Fax Number	:

Provider Business Practice Location Address
First Line	:	4647 ZION AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-2507
Country	:	US
Telephone Number	:	206-616-5781
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	11/29/2021

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Directions to “ JON THOMAS UMLAUF MD” Practice Location

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