Provider Demographics
NPI:1649218603
Name:LENTZ, JONATHAN D (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:D
Last Name:LENTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10777 HIGHWAY 412 W
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38351-6283
Mailing Address - Country:US
Mailing Address - Phone:731-968-5558
Mailing Address - Fax:731-968-5567
Practice Address - Street 1:10777 HIGHWAY 412 W
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:TN
Practice Address - Zip Code:38351-6283
Practice Address - Country:US
Practice Address - Phone:731-968-5558
Practice Address - Fax:731-968-5567
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31704208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
370023799OtherRAILROAD MEDICARE
TN3840642OtherMEDICAID
7048832OtherAETNA
TN12111OtherTLC
370023799OtherRAILROAD MEDICARE
TN4118593OtherBLUDCROSS BLUSHIELD
TN3840642OtherMEDICAID