Provider Demographics
NPI:1649518424
Name:CRIST, JONATHAN DAVID (SA-C)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:DAVID
Last Name:CRIST
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1711 27TH ST
Mailing Address - Street 2:BRAUNLIN BUILDING, SUITE 206
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2654
Mailing Address - Country:US
Mailing Address - Phone:740-356-6395
Mailing Address - Fax:740-354-2138
Practice Address - Street 1:1711 27TH ST
Practice Address - Street 2:BRAUNLIN BUILDING, SUITE 206
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2654
Practice Address - Country:US
Practice Address - Phone:740-356-6395
Practice Address - Fax:740-354-2138
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant