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:
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Health care specialties

SpecialtyCodeLicense #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 2 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1942219803 NPPES
Colorado MEDICAID 01727541

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