Provider Demographics
NPI:1275808305
Name:ROUNDTREE, JONATHAN ARLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:ARLEN
Last Name:ROUNDTREE
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 1:6810 JEFFERSON HWY. MILLENIUM APTS.TOWN CENTER
Mailing Address - Street 2:APT. # 5108
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-5108
Mailing Address - Country:US
Mailing Address - Phone:225-276-4179
Mailing Address - Fax:
Practice Address - Street 1:504 MAYFLOWER ST
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70802-6419
Practice Address - Country:US
Practice Address - Phone:225-342-1320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA020082207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine