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General NPI Number Information
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NPI Number | 1760582316
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Entity Type | Individual
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Provider Name | ROY E JONAS MD
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Gender | Male
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Dates
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Enumeration Date | 09/24/2006
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Last Update Date | 03/22/2021
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Provider Practice Location Address
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Address Line | 300 RIVERSIDE DR STE 2400
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City | BOURBONNAIS
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State | IL
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Zip | 60914-5068
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Country | US
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Telephone | 815-935-4907
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Fax | 815-935-1723
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Provider Business Mailing Address
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Address Line | 300 RIVERSIDE DR STE 2400
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City | BOURBONNAIS
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State | IL
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Zip | 60914-5068
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Country | US
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Telephone | 815-935-4907
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Fax | 815-935-1723
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036102006
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License Number State | IL
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