Doctor Name: | JONATHAN PHILIP DOLLISON |
NPI Number: | 1033442975 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | P.A. |
License Number: | |
Business Practice Address: | 2106 W Market St Rockport, TX - 783827312 |
Business Phone Number: | 3617298686 |
Business Fax Number: | |
Mailing Address: | 2106 W Market St, ROCKPORT |
State: | TX |
Postal Code: | 783827312 |
Phone Number: | 3617298686 |
Fax Number: | |
NPI Enumeration Date: | 09/10/2009 |
NPI Last Update Date: | 03/09/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AS0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | TX |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Surgical |
Taxonomy Definition: |