Provider Demographics
NPI:1154398733
Name:TONTZ, WILLIAM L SR (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:L
Last Name:TONTZ
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 W. 24TH STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364
Mailing Address - Country:US
Mailing Address - Phone:928-336-7846
Mailing Address - Fax:928-336-1776
Practice Address - Street 1:1501 W 24TH STREET
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364
Practice Address - Country:US
Practice Address - Phone:928-336-7846
Practice Address - Fax:928-336-1776
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG41138174400000X
AZ44869207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G411380Medicaid
CA200029494OtherRR MEDICARE
AZ877704Medicaid
CA200029494OtherRR MEDICARE
CAA92235Medicare UPIN
CAG41138Medicare ID - Type Unspecified
AZ877704Medicaid