MEDICARE: JONAS ERIC DRAVLAND M.D.

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	208M00000X	Hospitalist Physician	M-16945	ID
2	208M00000X	Hospitalist Physician	PT18845	ND
3	208M00000X	Hospitalist Physician	66911	MN
4	208000000X	Pediatrics Physician	9300458	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	29171	OTHER	NC	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134164502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONAS ERIC DRAVLAND M.D.

Provider Business Mailing Address
First Line	:	PO BOX 710
Second Line	:
City	:	LENOIR
State	:	NC
Zip	:	28645-0710
Country	:	US
Telephone Number	:	828-757-5070
Fax Number	:	828-757-7882

Provider Business Practice Location Address
First Line	:	401 MULBERRY ST SW
Second Line	:	STE 202
City	:	LENOIR
State	:	NC
Zip	:	28645-5463
Country	:	US
Telephone Number	:	828-757-5509
Fax Number	:	828-757-5538

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

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	01/13/2023

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