Provider Demographics
NPI:1356971857
Name:STINSON, JONATHAN P
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:P
Last Name:STINSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4292 MARQUETTE DR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-1838
Mailing Address - Country:US
Mailing Address - Phone:334-268-9824
Mailing Address - Fax:
Practice Address - Street 1:4292 MARQUETTE DR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1838
Practice Address - Country:US
Practice Address - Phone:334-268-9824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS12724390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program