MEDICARE: DR. JONATHAN B PINE DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	25MB05029700	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013999598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN B PINE DO

Provider Business Mailing Address
First Line	:	401 W PENNSYLVANIA AVE
Second Line	:
City	:	ANACONDA
State	:	MT
Zip	:	59711-1931
Country	:	US
Telephone Number	:	406-563-8500
Fax Number	:	406-563-8694

Provider Business Practice Location Address
First Line	:	305 W PENNSYLVANIA AVE
Second Line	:
City	:	ANACONDA
State	:	MT
Zip	:	59711
Country	:	US
Telephone Number	:	406-563-8571
Fax Number	:	406-563-8523

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	05/31/2018

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