Provider Demographics
NPI:1598152217
Name:CHURCH, JONATHAN ALEXANDER (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ALEXANDER
Last Name:CHURCH
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 1:8015 SHOAL CREEK BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-8051
Mailing Address - Country:US
Mailing Address - Phone:512-467-7246
Mailing Address - Fax:
Practice Address - Street 1:8015 SHOAL CREEK BLVD STE 103
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-8051
Practice Address - Country:US
Practice Address - Phone:512-467-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-20
Last Update Date:2022-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS5584207L00000X, 207LP2900X
IL036.148057207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology