Provider Demographics
NPI:1881777548
Name:JONAS, CECIL RODWELL (MD)
Entity type:Individual
Prefix:DR
First Name:CECIL
Middle Name:RODWELL
Last Name:JONAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:C
Other - Middle Name:R
Other - Last Name:JONAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4272 SW 186TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2771
Mailing Address - Country:US
Mailing Address - Phone:954-438-9943
Mailing Address - Fax:954-517-1292
Practice Address - Street 1:4272 SW 186TH AVE
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029-2771
Practice Address - Country:US
Practice Address - Phone:954-438-9943
Practice Address - Fax:954-517-1292
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16633207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIA79440Medicare UPIN
MI06358741611Medicare ID - Type Unspecified