Provider Demographics
NPI:1629272281
Name:ESPANA, JONATHAN MAYCOL (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:MAYCOL
Last Name:ESPANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:112 LAKE BRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-1879
Mailing Address - Country:US
Mailing Address - Phone:281-337-7908
Mailing Address - Fax:
Practice Address - Street 1:6651 MAIN ST STE F1500
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:713-797-1144
Practice Address - Fax:832-825-7775
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP1-0022200207V00000X
TXN4402207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2766284566OtherMYUTMB 2766284566-COMMERCIAL NUMBER