Provider Demographics
NPI:1760639082
Name:OSORIO-MCKENNA, JONATHAN I (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:I
Last Name:OSORIO-MCKENNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JONATHAN
Other - Middle Name:I
Other - Last Name:OSORIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:630 E STAR CT
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-6702
Mailing Address - Country:US
Mailing Address - Phone:970-240-0378
Mailing Address - Fax:970-240-3346
Practice Address - Street 1:816 S 5TH ST
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-5765
Practice Address - Country:US
Practice Address - Phone:970-249-3322
Practice Address - Fax:970-240-7976
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO48243207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine