Provider Demographics
NPI:1083652051
Name:GOPEZ, JONAS JOAQUIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JONAS
Middle Name:JOAQUIN
Last Name:GOPEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2510 MARYLAND RD
Mailing Address - Street 2:STE185
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1109
Mailing Address - Country:US
Mailing Address - Phone:215-657-5886
Mailing Address - Fax:215-657-5844
Practice Address - Street 1:2510 MARYLAND RD
Practice Address - Street 2:STE185
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1109
Practice Address - Country:US
Practice Address - Phone:215-657-5886
Practice Address - Fax:215-657-5844
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD071551L207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1008171110002Medicaid
PABG7099446OtherDEA
PA072184Medicare PIN
PAH91405Medicare UPIN