Provider Demographics
NPI:1578536363
Name:STRONG, JONATHON WILLIAM (DPM)
Entity Type:Individual
Prefix:DR
First Name:JONATHON
Middle Name:WILLIAM
Last Name:STRONG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1705 CHRISTY DR
Mailing Address - Street 2:SUITE 209
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65101-5195
Mailing Address - Country:US
Mailing Address - Phone:573-638-2655
Mailing Address - Fax:573-634-3985
Practice Address - Street 1:1705 CHRISTY DR
Practice Address - Street 2:SUITE 209
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-5195
Practice Address - Country:US
Practice Address - Phone:573-638-2655
Practice Address - Fax:573-634-3985
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002018117213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP00167638OtherMEDICARE RAILROAD
MO305861916Medicaid
MOU90594Medicare UPIN
MO305861916Medicaid