Individual
JEREMY BONZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
336 29TH ST STE 101, ASHLAND, KY 41101-1976
(606) 324-4404
Mailing address
PO BOX 2379, ASHLAND, KY 41105-2379
(606) 408-6200
(606) 408-6612
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
50642
KY
208800000X
Urology Physician
MT202082
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100485660
—
KY
Enumeration date
06/06/2012
Last updated
11/18/2021
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