Provider Demographics
NPI:1710148937
Name:JEWKES, JONATHAN STANLEY (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:STANLEY
Last Name:JEWKES
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:PO BOX 492080
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96049-2080
Mailing Address - Country:US
Mailing Address - Phone:530-243-1236
Mailing Address - Fax:530-245-5949
Practice Address - Street 1:2020 COURT ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1822
Practice Address - Country:US
Practice Address - Phone:530-243-1236
Practice Address - Fax:530-245-5949
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43015076902085R0202X
MO2008016543208600000X
CAA1255752085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA142212OtherMEDICARE PTAN
CACA141087OtherMEDICARE PTAN