Provider Demographics
NPI:1801870589
Name:BORJESON, JONATHAN C (DO)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:C
Last Name:BORJESON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14701 179TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-1108
Mailing Address - Country:US
Mailing Address - Phone:360-794-7497
Mailing Address - Fax:360-805-3456
Practice Address - Street 1:14841 179TH AVE SE, SUITE 220
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-1108
Practice Address - Country:US
Practice Address - Phone:360-217-1153
Practice Address - Fax:360-217-1156
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00002254208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1045714Medicaid
H15390Medicare UPIN
61980Medicare ID - Type Unspecified