Healthcare Provider Details

I. General information

NPI: 1386641462
Provider Name (Legal Business Name): JONATHAN S WARE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 04/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6312 US 301 N
ELLENTON FL
34222-3066
US

IV. Provider business mailing address

PO BOX 25487
SARASOTA FL
34277-2487
US

V. Phone/Fax

Practice location:
  • Phone: 941-847-1101
  • Fax: 941-417-2811
Mailing address:
  • Phone: 941-202-5342
  • Fax: 855-253-4836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME84821
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: