Provider Demographics
NPI:1184622714
Name:SOLIS, JON STEPHEN (MD)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:STEPHEN
Last Name:SOLIS
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 1:17 WELLS ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-2923
Mailing Address - Country:US
Mailing Address - Phone:401-348-0660
Mailing Address - Fax:401-348-3090
Practice Address - Street 1:17 WELLS ST
Practice Address - Street 2:SUITE 203
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-2923
Practice Address - Country:US
Practice Address - Phone:401-348-0660
Practice Address - Fax:401-348-3090
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD08530207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIJS04203Medicaid
RI03-00143OtherUHC
RI20185-2OtherBCBS
E69909Medicare UPIN
RI079020185Medicare ID - Type Unspecified