Provider Demographics
NPI:1336308162
Name:HEATH, JONATHON EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:JONATHON
Middle Name:EDWARD
Last Name:HEATH
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 1:5751 HOOVER BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-5340
Mailing Address - Country:US
Mailing Address - Phone:813-886-8334
Mailing Address - Fax:813-886-8334
Practice Address - Street 1:5751 HOOVER BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-5340
Practice Address - Country:US
Practice Address - Phone:813-886-8334
Practice Address - Fax:813-886-8334
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD74171207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD055395600Medicaid
MD240989YWBMedicare PIN