Provider Demographics
NPI:1952496127
Name:MEDVERD, JONATHAN R (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:R
Last Name:MEDVERD
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VAPSHCS - SEATTLE DIVISION
Mailing Address - Street 2:1660 SOUTH COLUMBIAN WAY, S-113RAD
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-1597
Mailing Address - Country:US
Mailing Address - Phone:206-764-2444
Mailing Address - Fax:206-277-3415
Practice Address - Street 1:VAPSHCS - SEATTLE DIVISION
Practice Address - Street 2:1660 SOUTH COLUMBIAN WAY, S-113RAD
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-1597
Practice Address - Country:US
Practice Address - Phone:206-764-2444
Practice Address - Fax:206-277-3415
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA025209 MD000352272085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG84731Medicare UPIN