Provider Demographics
NPI:1609031475
Name:DANIEL, JONATHAN C (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:C
Last Name:DANIEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:9135 SW BARNES RD STE 963
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6699
Mailing Address - Country:US
Mailing Address - Phone:503-297-1419
Mailing Address - Fax:503-216-2488
Practice Address - Street 1:9155 SW BARNES RD
Practice Address - Street 2:STE. 240
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6625
Practice Address - Country:US
Practice Address - Phone:503-297-1419
Practice Address - Fax:503-216-2488
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD156953208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500643863Medicaid
ORR163984Medicare PIN