Active NPI
Jon Franklin Sandoval
- Driver
- Green Bay, WI
National Provider Identifier
1932988573
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Driver
- License
- S53142667140-01
- Practice address
- 1617 River Bend Ter Apt 9
Green Bay, WI 54311-4203 - Phone
- (920) 784-9944
- NPI assigned
- Sep 25, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | S53142667140-01 | WI | Primary |
Addresses
Primary practice location
1617 River Bend Ter Apt 9
Green Bay, WI 54311-4203
Mailing address
1617 River Bend Ter Apt 9
Green Bay, WI 54311-4203
Phone (920) 784-9944
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S53142667140-01 | WI | MD | Driver |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1695600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695600000000",
"number": "1932988573",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1617 RIVER BEND TER APT 9",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543114203",
"telephone_number": "920-784-9944"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1617 RIVER BEND TER APT 9",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543114203",
"telephone_number": "920-784-9944"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SANDOVAL",
"first_name": "JON",
"middle_name": "FRANKLIN",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-09-25",
"last_updated": "2023-09-25",
"certification_date": "2023-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "172A00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Driver",
"state": "WI",
"license": "S53142667140-01",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Green Bay, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.