Provider Demographics
NPI:1083672919
Name:ALLEY, JONATHAN E (DO)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:E
Last Name:ALLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:ANGOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46703-1556
Mailing Address - Country:US
Mailing Address - Phone:260-665-5170
Mailing Address - Fax:260-665-6979
Practice Address - Street 1:424 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703-1556
Practice Address - Country:US
Practice Address - Phone:260-665-5170
Practice Address - Fax:260-665-6979
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50003955A207Q00000X
IN20014061207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000263260OtherBS
IN0004416561OtherAETNA
IN5463OtherPHP
IN771350Medicare ID - Type UnspecifiedMEDICARE
IN0004416561OtherAETNA