Provider Demographics
NPI:1790840965
Name:RITSON, JONATHAN L (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:L
Last Name:RITSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 JAHN AVE NW STE A7
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-8900
Mailing Address - Country:US
Mailing Address - Phone:253-514-6547
Mailing Address - Fax:253-514-8631
Practice Address - Street 1:2200 NORTH 30TH STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98403
Practice Address - Country:US
Practice Address - Phone:253-779-5858
Practice Address - Fax:253-779-5757
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00024441208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1316246234OtherNPI
1087121OtherIDSHS
115000039Medicare ID - Type Unspecified