Individual
DR. JON LEE STOCKRAHM
Active
Individual
DR. JON LEE STOCKRAHM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
02002047
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000211750
ANTHEM
IN
01
—
110232365
RAILROAD MEDICARE
IN
05
—
200227720A
—
IN
01
—
5902718
AETNA
IN
Enumeration date
06/30/2005
Last updated
12/03/2024
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