Provider Demographics
NPI:1871544817
Name:WALZ, JON H JR (DO)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:H
Last Name:WALZ
Suffix:JR
Gender:M
Credentials:DO
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Mailing Address - Street 1:105 PONDER CT
Mailing Address - Street 2:STE 104
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-9050
Mailing Address - Country:US
Mailing Address - Phone:606-327-0077
Mailing Address - Fax:606-833-9453
Practice Address - Street 1:1000 ASHLAND DR
Practice Address - Street 2:SUITE 105
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7057
Practice Address - Country:US
Practice Address - Phone:606-327-0077
Practice Address - Fax:606-833-9453
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2019-06-12
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Provider Licenses
StateLicense IDTaxonomies
KY02629207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64990468Medicaid
KYG07127Medicare UPIN
KY00139001Medicare PIN