Provider Demographics
NPI:1659071652
Name:PATMORE, JONATHON WILLIAM
Entity Type:Individual
Prefix:MR
First Name:JONATHON
Middle Name:WILLIAM
Last Name:PATMORE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 S WINTER LN
Mailing Address - Street 2:
Mailing Address - City:SANTA CLAUS
Mailing Address - State:IN
Mailing Address - Zip Code:47579-6046
Mailing Address - Country:US
Mailing Address - Phone:812-686-0146
Mailing Address - Fax:
Practice Address - Street 1:510 S WINTER LN
Practice Address - Street 2:
Practice Address - City:SANTA CLAUS
Practice Address - State:IN
Practice Address - Zip Code:47579-6046
Practice Address - Country:US
Practice Address - Phone:812-686-0146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program