Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | OS14198 | FL |
NPI | 1437414711 |
---|---|
Provider Name | Dr. Jonathan Wayne Vonkoenig |
First Address | Fort Myers, FL 33902-2147 |
Second Address | Fort Myers, FL 33905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2012 |
Last Update Date | 30/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
018988100 | (05) | FL |