Provider Demographics
NPI:1801831342
Name:PLACIDE, JON S (MD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:S
Last Name:PLACIDE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11001 DURANT RD
Mailing Address - Street 2:STE 100
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-8390
Mailing Address - Country:US
Mailing Address - Phone:919-781-2500
Mailing Address - Fax:919-781-9247
Practice Address - Street 1:11001 DURANT RD
Practice Address - Street 2:STE 100
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-8390
Practice Address - Country:US
Practice Address - Phone:919-781-2500
Practice Address - Fax:919-781-9247
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2018-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC2005-00594207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5903985Medicaid
NC5903985Medicaid
NC2052885AMedicare PIN