Provider Demographics
NPI:1902245780
Name:CAMPBELL, JONATHON JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHON
Middle Name:JAMES
Last Name:CAMPBELL
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 1:160 W CAMINO REAL # 270
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-5942
Mailing Address - Country:US
Mailing Address - Phone:561-759-8591
Mailing Address - Fax:
Practice Address - Street 1:1450 SW 17TH ST
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-6506
Practice Address - Country:US
Practice Address - Phone:561-759-8591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-14
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME121934207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine