Provider Demographics
NPI:1710445390
Name:SOMMER, JONATHAN PAUL
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:PAUL
Last Name:SOMMER
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 1:1621 OSAGE TRL APT 1
Mailing Address - Street 2:
Mailing Address - City:DALHART
Mailing Address - State:TX
Mailing Address - Zip Code:79022-5142
Mailing Address - Country:US
Mailing Address - Phone:346-305-9738
Mailing Address - Fax:
Practice Address - Street 1:1411 DENVER AVE
Practice Address - Street 2:
Practice Address - City:DALHART
Practice Address - State:TX
Practice Address - Zip Code:79022-4809
Practice Address - Country:US
Practice Address - Phone:346-305-9738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2143498208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation