Provider Demographics
NPI:1821352881
Name:SELBST, JONATHAN R (DPM)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:R
Last Name:SELBST
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:5175 W ATLANTIC AVE
Mailing Address - Street 2:STE F
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-8101
Mailing Address - Country:US
Mailing Address - Phone:561-638-8635
Mailing Address - Fax:561-638-8632
Practice Address - Street 1:5175 W ATLANTIC AVE
Practice Address - Street 2:STE F
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-8101
Practice Address - Country:US
Practice Address - Phone:561-638-8635
Practice Address - Fax:561-638-8632
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPO3651213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery