Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 036-114186 | IL |
N | 111NI0900X | Internist | 036-114186 | IL |
N | 207R00000X | Internist | 50318-020 | WI |
N | 111NI0900X | Internist | 50318-020 | WI |
Y | 207RG0100X | Gastroenterologist | 2010003215 | MO |
NPI | 1003895749 |
---|---|
Provider Name | Dr. Jonathan Philip Horwitz |
First Address | Independence, MO 64055-0000 |
Second Address | Liberty, MO 64068-3388 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2006 |
Last Update Date | 03/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I39914 | (02) | MO |