Provider Demographics
NPI:1811159619
Name:PRIBAZ, JONATHAN R (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:R
Last Name:PRIBAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2300 M ST NW
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-1434
Mailing Address - Country:US
Mailing Address - Phone:202-741-3301
Mailing Address - Fax:202-741-3313
Practice Address - Street 1:2300 M ST NW
Practice Address - Street 2:5TH FLOOR
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-1434
Practice Address - Country:US
Practice Address - Phone:202-741-3301
Practice Address - Fax:202-741-3313
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
DCMD043532207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program