Provider Demographics
NPI:1386641462
Name:WARE, JONATHAN S (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:S
Last Name:WARE
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:PO BOX 25487
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34277-2487
Mailing Address - Country:US
Mailing Address - Phone:941-202-5342
Mailing Address - Fax:855-253-4836
Practice Address - Street 1:6312 US 301 N
Practice Address - Street 2:
Practice Address - City:ELLENTON
Practice Address - State:FL
Practice Address - Zip Code:34222-3066
Practice Address - Country:US
Practice Address - Phone:941-847-1101
Practice Address - Fax:941-417-2811
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84821207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267895100Medicaid
FL62803AOtherBCBS FLORIDA
FL62803AOtherBCBS FLORIDA
H76173Medicare UPIN