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General NPI Number Information
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NPI Number | 1033442975
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Entity Type | Individual
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Provider Name | JONATHAN PHILIP DOLLISON P.A.
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Gender | Male
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Dates
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Enumeration Date | 09/10/2009
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 5710 ESPLANADE DRIVE
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City | CORPUS CHRISTI
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State | TX
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Zip | 78414-4165
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Country | US
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Telephone | 361-991-8000
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Fax | 877-494-7986
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Provider Business Mailing Address
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Address Line | PO BOX 850
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City | ALICE
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State | TX
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Zip | 78333-0850
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Country | US
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Telephone | 361-664-0303
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Fax | 866-846-0933
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA06396
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License Number State | TX
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