Provider Demographics
NPI:1396421467
Name:KROES, JONATHAN FABIAN
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:FABIAN
Last Name:KROES
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 1:506 HONEA EGYPT RD STE 905
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-2568
Mailing Address - Country:US
Mailing Address - Phone:346-334-6388
Mailing Address - Fax:
Practice Address - Street 1:419 KELLY RD
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-5254
Practice Address - Country:US
Practice Address - Phone:346-334-6388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-23
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver