Doctor Name: | JONATHAN GORDON WASH |
NPI Number: | 1003899972 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.P.M. |
License Number: | 1750 |
Business Practice Address: | 5100 Franklin Ave Suite C Waco, TX - 767106922 |
Business Phone Number: | 2547411824 |
Business Fax Number: | 2547542667 |
Mailing Address: | 5100 Franklin Ave, Suite C WACO |
State: | TX |
Postal Code: | 767106922 |
Phone Number: | 2547411824 |
Fax Number: | 2547542667 |
NPI Enumeration Date: | 11/23/2005 |
NPI Last Update Date: | 08/26/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0103X |
License Number: | 1750 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot & Ankle Surgery |
Taxonomy Definition: |