Provider Demographics
NPI:1952186108
Name:MARX, JONATHAN ANDREW (RRA, RT(R)(ARRT)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ANDREW
Last Name:MARX
Suffix:
Gender:M
Credentials:RRA, RT(R)(ARRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5723 BUCK RUN DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33811-2038
Mailing Address - Country:US
Mailing Address - Phone:859-803-5878
Mailing Address - Fax:
Practice Address - Street 1:2125 CRYSTAL GROVE DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-6875
Practice Address - Country:US
Practice Address - Phone:863-688-2334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRA61243U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant