Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 34.009681 | OH |
Y | 207QS0010X | Family Doctor - Sports Medicine | 34.009681 | OH |
N | 207R00000X | Internist | 34.009681 | OH |
N | 111NI0900X | Internist | 34.009681 | OH |
NPI | 1083800361 |
---|---|
Provider Name | Michael A Jonesco |
First Address | Columbus, OH 43202-1559 |
Second Address | Gahanna, OH 43230-1757 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2007 |
Last Update Date | 25/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3042782 | (05) | OH |