Provider Demographics
NPI:1114255601
Name:JONATHAN W PINO MD PLLC
Entity Type:Organization
Organization Name:JONATHAN W PINO MD PLLC
Other - Org Name:CANTON XPRESSMED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:PINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-613-5202
Mailing Address - Street 1:454 VZ COUNTY ROAD 2206
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:TX
Mailing Address - Zip Code:75103-5351
Mailing Address - Country:US
Mailing Address - Phone:940-613-5202
Mailing Address - Fax:903-225-1995
Practice Address - Street 1:301 E STATE HIGHWAY 243 STE 121
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:TX
Practice Address - Zip Code:75103-2418
Practice Address - Country:US
Practice Address - Phone:903-567-4692
Practice Address - Fax:903-225-1995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A5879Medicare PIN