Basic Information
| Provider Information | |||||||||
| NPI: | 1356332373 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | UMLAUF | ||||||||
| FirstName: | JON | ||||||||
| MiddleName: | THOMAS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4647 ZION AVE | ||||||||
| Address2: | NUCLEAR MEDICINE DEPARTMENT | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921202507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195286567 | ||||||||
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| Address1: | 4647 ZION AVE | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921202507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2066165781 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2005 | ||||||||
| LastUpdateDate: | 11/29/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 25MA56685 | NJ | N | Allopathic & Osteopathic Physicians | Family Medicine | 207U00000X | MD00046429 | WA | N | Allopathic & Osteopathic Physicians | Nuclear Medicine | 2083A0100X | 25MA56685 | NJ | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Aerospace Medicine | 208D00000X | 25MA56685 | NJ | N | Allopathic & Osteopathic Physicians | General Practice | 207U00000X | G89012 | CA | Y | Allopathic & Osteopathic Physicians | Nuclear Medicine |
No ID Information.