Provider Demographics
NPI:1558317644
Name:JONASON, NEIL E (MD)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:E
Last Name:JONASON
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 1:1027 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501-3409
Mailing Address - Country:US
Mailing Address - Phone:218-847-5611
Mailing Address - Fax:218-847-0881
Practice Address - Street 1:1027 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-3409
Practice Address - Country:US
Practice Address - Phone:218-847-5611
Practice Address - Fax:218-847-0881
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN26966207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0106050OtherMEDICA #
MN116791OtherUCARE #
MNDA9031015652OtherPREFERRED ONE #
MNHP19548OtherHEALTHPARTNERS #
MN0106048OtherMEDICA #
MN16653Medicaid
MN2367OtherSIOUX VALLEY #
MN6469OtherNDBS #
MN911325OtherAMERICA'S PPO/ARAZ #
MN054063300Medicaid
MN24325JOOtherMNBS #
MN6465OtherNDBS #
MNMN100023OtherLHS/BANNERHEALTH #
MN089004402Medicare ID - Type UnspecifiedMN MEDICARE #
MN0106050OtherMEDICA #
MN2367OtherSIOUX VALLEY #