MEDICARE: JONATHON JAIR TOVAR

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	2255A2300X	Athletic Trainer	AT7938	TX

General Provider Information

NPI Number	:	1538720065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHON JAIR TOVAR

Provider Business Mailing Address
First Line	:	7527 CLAIRSON LN
Second Line	:
City	:	CYPRESS
State	:	TX
Zip	:	77433-1330
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 BOWERS BLVD
Second Line	:
City	:	HUNTSVILLE
State	:	TX
Zip	:	77341-0001
Country	:	US
Telephone Number	:	936-294-1985
Fax Number	:

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

Provider Enumeration Date	:	06/25/2019
Last Update Date	:	06/25/2019

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