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General NPI Number Information
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NPI Number | 1083884787
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Entity Type | Organization
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Legal Business Name | JON M NORTHAM, M.D.,P.A.
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Dates
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Enumeration Date | 03/10/2008
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Last Update Date | 06/24/2010
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Provider Practice Location Address
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Address Line | 6 WOODMONT XING
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City | TEXARKANA
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State | TX
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Zip | 75503-2100
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Country | US
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Telephone | 903-791-1044
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Fax | 903-791-1047
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Provider Business Mailing Address
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Address Line | 6 WOODMONT XING
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City | TEXARKANA
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State | TX
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Zip | 75503-2100
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Country | US
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Telephone | 903-791-1044
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Fax | 903-791-1047
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Authorized Official
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Title or Position | OWNER
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Name | MR. JON MARK NORTHAM
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Credential | M.D., P.A.
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Telephone | 903-791-1044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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