Provider Demographics
NPI:1386178705
Name:SROUR, JONATHON (DPM)
Entity Type:Individual
Prefix:
First Name:JONATHON
Middle Name:
Last Name:SROUR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7016 LEE PARK RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-3682
Mailing Address - Country:US
Mailing Address - Phone:804-746-5488
Mailing Address - Fax:804-730-1223
Practice Address - Street 1:7016 LEE PARK RD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-3682
Practice Address - Country:US
Practice Address - Phone:804-746-5488
Practice Address - Fax:804-730-1223
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-12
Last Update Date:2021-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5678213ES0103X
VA0103301310213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty