Healthcare Provider Details

I. General information

NPI: 1134164502
Provider Name (Legal Business Name): JONAS ERIC DRAVLAND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 01/13/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 MULBERRY ST SW STE 202
LENOIR NC
28645-5463
US

IV. Provider business mailing address

PO BOX 710
LENOIR NC
28645-0710
US

V. Phone/Fax

Practice location:
  • Phone: 828-757-5509
  • Fax: 828-757-5538
Mailing address:
  • Phone: 828-757-5070
  • Fax: 828-757-7882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberM-16945
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberPT18845
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number66911
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9300458
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: