Provider Demographics
NPI:1912295783
Name:DEMING, JONATHAN M (DPM)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:M
Last Name:DEMING
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:211 N EDDY ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-2808
Mailing Address - Country:US
Mailing Address - Phone:574-259-9668
Mailing Address - Fax:574-259-9671
Practice Address - Street 1:211 N EDDY ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-2808
Practice Address - Country:US
Practice Address - Phone:574-259-9668
Practice Address - Fax:574-259-9671
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN07001143A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist