Provider Demographics
NPI:1376532697
Name:OLEGARIO, JONATHAN CACERES (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:CACERES
Last Name:OLEGARIO
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 1:1408 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-2175
Mailing Address - Country:US
Mailing Address - Phone:605-996-8066
Mailing Address - Fax:605-996-9194
Practice Address - Street 1:120 W 6TH AVE
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-1920
Practice Address - Country:US
Practice Address - Phone:605-996-9141
Practice Address - Fax:605-996-9194
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5718207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine