Provider Demographics
NPI:1306200548
Name:ROHLOFF, JONATHAN PAUL
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:PAUL
Last Name:ROHLOFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2259 GREEN MEADOWS CIR
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-3245
Mailing Address - Country:US
Mailing Address - Phone:402-320-0715
Mailing Address - Fax:
Practice Address - Street 1:4 E CLARK BASS BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-4269
Practice Address - Country:US
Practice Address - Phone:918-421-6795
Practice Address - Fax:918-421-6791
Is Sole Proprietor?:No
Enumeration Date:2016-04-13
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6242207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine