Bonzo, Jeremy
Bonzo, Jeremy is an individual health care provider with primary practice located at 336 29Th St Ste 101 , Ashland KY 41101-1976. He recently has only one registered license in Allopathic & Osteopathic Physicians / Urology, which is considered as his primary health care specialty. Bonzo, Jeremy can be contacted via phone (606) 324-4404.Contact Information
Primary practice address
336 29Th St Ste 101
Ashland KY 41101-1976
Phone: (606) 324-4404
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Urology | 208800000X | MT202082 | Pennsylvania |
| Allopathic & Osteopathic Physicians / Urology | 208800000X | 50642 | Kentucky |
Profile Details
| NPI number | 1447511332 |
|---|---|
| LBN Legal business name | Bonzo, Jeremy |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 6th, 2012 |
| Last updated | Nov 18th, 2021 - about 3 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 | 1447511332 | NPPES |
| Kentucky | MEDICAID | 7100485660 |
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