Provider Demographics
NPI:1225135221
Name:MCBRIDE, JONATHAN EG (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:EG
Last Name:MCBRIDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3705 S MERIDIAN STE B
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-3709
Mailing Address - Country:US
Mailing Address - Phone:253-765-5050
Mailing Address - Fax:844-695-2929
Practice Address - Street 1:3705 S MERIDIAN STE B
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3709
Practice Address - Country:US
Practice Address - Phone:253-765-5050
Practice Address - Fax:844-695-2929
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD26965207Q00000X
WAMD00046768207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1038955Medicaid
OR028419Medicaid
OR028419Medicaid