Provider Demographics
NPI:1952416380
Name:EBBING, JONATHAN JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:JAMES
Last Name:EBBING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 7TH AVE
Mailing Address - Street 2:KAISER PERMANENTE LONGVIEW-KELSO MEDICAL OFFICE
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-3198
Mailing Address - Country:US
Mailing Address - Phone:360-636-6235
Mailing Address - Fax:360-575-4805
Practice Address - Street 1:1230 7TH AVE
Practice Address - Street 2:KAISER PERMANENTE LONGVIEW-KELSO MEDICAL OFFICE
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3198
Practice Address - Country:US
Practice Address - Phone:360-636-6235
Practice Address - Fax:360-575-4805
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000463272084P0800X
ORMD267392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry