Provider Demographics
NPI:1134164502
Name:DRAVLAND, JONAS ERIC (MD)
Entity type:Individual
Prefix:
First Name:JONAS
Middle Name:ERIC
Last Name:DRAVLAND
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:PO BOX 710
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-0710
Mailing Address - Country:US
Mailing Address - Phone:828-757-5070
Mailing Address - Fax:828-757-7882
Practice Address - Street 1:401 MULBERRY ST SW
Practice Address - Street 2:STE 202
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-5463
Practice Address - Country:US
Practice Address - Phone:828-757-5509
Practice Address - Fax:828-757-5538
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-16945208M00000X
NDPT18845208M00000X
MN66911208M00000X
NC9300458208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC29171OtherBCBS
NC8929171Medicaid
NC8929171Medicaid