Provider Demographics
NPI:1164919379
Name:THEO, JONATHAN (DO)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:THEO
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 1:5235 OVERPASS RD
Mailing Address - Street 2:
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-9750
Mailing Address - Country:US
Mailing Address - Phone:512-504-0888
Mailing Address - Fax:
Practice Address - Street 1:5235 OVERPASS RD
Practice Address - Street 2:
Practice Address - City:BUDA
Practice Address - State:TX
Practice Address - Zip Code:78610-9750
Practice Address - Country:US
Practice Address - Phone:512-504-0888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-13
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT67302084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology