Provider Demographics
NPI:1275558686
Name:JONAS, GWENDA C (MD)
Entity Type:Individual
Prefix:
First Name:GWENDA
Middle Name:C
Last Name:JONAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 SUNNYVIEW LN STE 201
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3128
Mailing Address - Country:US
Mailing Address - Phone:406-752-5252
Mailing Address - Fax:406-752-5261
Practice Address - Street 1:210 SUNNYVIEW LN STE 201
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3128
Practice Address - Country:US
Practice Address - Phone:406-752-5252
Practice Address - Fax:406-752-5261
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9764174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT92716502OtherMONTANA BREAST & CERVICAL
MT0069632Medicaid
MT095561OtherBCBS
MT095561OtherBCBS