Provider Demographics
NPI:1477991925
Name:PHILIPPE, JONATHAN (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:PHILIPPE
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 1:2703 RUNNING HORSE RD
Mailing Address - Street 2:
Mailing Address - City:PLATTE CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64079-7707
Mailing Address - Country:US
Mailing Address - Phone:816-858-7050
Mailing Address - Fax:816-858-7055
Practice Address - Street 1:2703 RUNNING HORSE RD
Practice Address - Street 2:
Practice Address - City:PLATTE CITY
Practice Address - State:MO
Practice Address - Zip Code:64079-7707
Practice Address - Country:US
Practice Address - Phone:816-858-7050
Practice Address - Fax:816-858-7055
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-06
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD42863207Q00000X
MO2016023357207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine