MEDICARE: DR. JONATHAN JAMES EBBING M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	MD00046327	WA
2	2084P0800X	Psychiatry Physician	MD26739	OR

General Provider Information

NPI Number	:	1952416380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN JAMES EBBING M.D.

Provider Business Mailing Address
First Line	:	1230 7TH AVE
Second Line	:	KAISER PERMANENTE LONGVIEW-KELSO MEDICAL OFFICE
City	:	LONGVIEW
State	:	WA
Zip	:	98632-3198
Country	:	US
Telephone Number	:	360-636-6235
Fax Number	:	360-575-4805

Provider Business Practice Location Address
First Line	:	1230 7TH AVE
Second Line	:	KAISER PERMANENTE LONGVIEW-KELSO MEDICAL OFFICE
City	:	LONGVIEW
State	:	WA
Zip	:	98632-3198
Country	:	US
Telephone Number	:	360-636-6235
Fax Number	:	360-575-4805

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	07/12/2007

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