Provider Demographics
NPI:1336724632
Name:LALE, JONATHAN THOMAS (PA)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:THOMAS
Last Name:LALE
Suffix:
Gender:M
Credentials:PA
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1805 SHEA CENTER DR STE 301
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2277
Mailing Address - Country:US
Mailing Address - Phone:303-814-0505
Mailing Address - Fax:303-814-6491
Practice Address - Street 1:7280 LAGAE RD STE J
Practice Address - Street 2:
Practice Address - City:CASTLE PINES
Practice Address - State:CO
Practice Address - Zip Code:80108-9454
Practice Address - Country:US
Practice Address - Phone:303-814-0505
Practice Address - Fax:303-814-6491
Is Sole Proprietor?:No
Enumeration Date:2021-03-17
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
COPA.0006571363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant