Individual
JON S VANWOERKOM
Active
Individual
JON S VANWOERKOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
10000482A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000374068
BCBS PIN
—
01
—
970018927
RAILROAD MEDICARE PIN
—
Enumeration date
07/14/2006
Last updated
07/19/2011
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