MEDICARE: MILTON JOHN VONTHRON M.D.

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	207XP3100X	Pediatric Orthopaedic Surgery Physician	ME63253	FL
2	207XS0106X	Orthopaedic Hand Surgery Physician	ME63253	FL
3	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician	ME63253	FL
4	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	ME63253	FL
5	207X00000X	Orthopaedic Surgery Physician	ME63253	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	200024455	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801890264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MILTON JOHN VONTHRON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 117345
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30368-7345
Country	:	US
Telephone Number	:	904-346-3465
Fax Number	:	904-858-6489

Provider Business Practice Location Address
First Line	:	1577 ROBERTS DR STE 225
Second Line	:	CREDENTIALING DEPARTMENT
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-3265
Country	:	US
Telephone Number	:	904-241-1204
Fax Number	:	904-241-7331

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	11/16/2020

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Directions to “ MILTON JOHN VONTHRON M.D.” Practice Location

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