Provider Demographics
NPI:1447431150
Name:JONATHAN B. STATON M.D., P.A.
Entity Type:Organization
Organization Name:JONATHAN B. STATON M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:BOND
Authorized Official - Last Name:STATON
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:281-256-8212
Mailing Address - Street 1:13611 SKINNER RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-1018
Mailing Address - Country:US
Mailing Address - Phone:281-256-8212
Mailing Address - Fax:281-256-8213
Practice Address - Street 1:13611 SKINNER RD
Practice Address - Street 2:SUITE 240
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-1018
Practice Address - Country:US
Practice Address - Phone:281-256-8212
Practice Address - Fax:281-256-8213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5573207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00338YMedicare PIN
TX8D2685Medicare UPIN