Provider Demographics
NPI:1598326597
Name:LINDER, JONATHAN WESLEY (NP)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:WESLEY
Last Name:LINDER
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 BUDDY GANEM DR STE A
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78374-3202
Mailing Address - Country:US
Mailing Address - Phone:361-777-3900
Mailing Address - Fax:361-413-0274
Practice Address - Street 1:1227 ENRIQUE M BARRERA PKWY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78227-2210
Practice Address - Country:US
Practice Address - Phone:210-538-8386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141894363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily