Provider Demographics
NPI:1003895749
Name:HORWITZ, JONATHAN PHILIP (DO)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:PHILIP
Last Name:HORWITZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17501 E 40 HWY
Mailing Address - Street 2:SUITE 213A
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-0000
Mailing Address - Country:US
Mailing Address - Phone:816-478-4778
Mailing Address - Fax:816-478-7140
Practice Address - Street 1:2521 GLENN HENDREN DR
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-3388
Practice Address - Country:US
Practice Address - Phone:816-478-4887
Practice Address - Fax:816-478-7140
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-114186207R00000X
WI50318-020207R00000X
MO2010003215207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO418A00024Medicare PIN
MOI39914Medicare UPIN