Healthcare Provider Details

I. General information

NPI: 1780760942
Provider Name (Legal Business Name): HOWARD STEPHEN JONAS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1606 BRIDGEWATER CENTER RD
BRIDGEWATER CORNERS VT
05035-9726
US

IV. Provider business mailing address

1606 BRIDGEWATER CENTER RD
BRIDGEWATER CORNERS VT
05035-9726
US

V. Phone/Fax

Practice location:
  • Phone: 802-672-3875
  • Fax:
Mailing address:
  • Phone: 802-672-3875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0320000234
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: