Medina, Jonathon Dominique
Medina, Jonathon Dominique is an sole proprietor health care provider with primary practice located at 1950 Bluegrass Cir Ste 200 , Cheyenne WY 82009-7364. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Medina, Jonathon Dominique can be contacted via phone (307) 778-2577.Contact Information
Primary practice address
1950 Bluegrass Cir Ste 200
Cheyenne WY 82009-7364
Phone: (307) 778-2577
Fax: (307) 635-2131
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 43517 | Colorado |
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 7156A | Wyoming |
Profile Details
| NPI number | 1942219803 |
|---|---|
| LBN Legal business name | Medina, Jonathon Dominique |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 7th, 2006 |
| Last updated | Oct 31st, 2022 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1942219803 | NPPES |
| Colorado | MEDICAID | 01727541 |
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