Provider Demographics
NPI:1306005905
Name:ALTOMAR, JONATHAN LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:LOUIS
Last Name:ALTOMAR
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 1:3146 BEDFORD LN
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38139-8037
Mailing Address - Country:US
Mailing Address - Phone:870-253-3771
Mailing Address - Fax:
Practice Address - Street 1:1005 E MATTHEWS AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4308
Practice Address - Country:US
Practice Address - Phone:870-935-1242
Practice Address - Fax:870-932-6809
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-1764208600000X
TN50661208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery