Provider Demographics
NPI:1013976240
Name:PLY, JONATHAN J (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:J
Last Name:PLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3911 HIGHWAY 17
Mailing Address - Street 2:SUITE A
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-5014
Mailing Address - Country:US
Mailing Address - Phone:843-651-8200
Mailing Address - Fax:843-651-8236
Practice Address - Street 1:3911 HIGHWAY 17
Practice Address - Street 2:SUITE A
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-5014
Practice Address - Country:US
Practice Address - Phone:843-651-8200
Practice Address - Fax:843-651-8236
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16671207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCC46720Medicare UPIN
SCC467207536Medicare PIN