Provider Demographics
NPI:1205977188
Name:TEW, JONATHAN MILTON (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:MILTON
Last Name:TEW
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 1:620 MEDICAL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-5084
Mailing Address - Country:US
Mailing Address - Phone:801-295-2888
Mailing Address - Fax:
Practice Address - Street 1:620 MEDICAL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-5084
Practice Address - Country:US
Practice Address - Phone:801-295-2888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT350706-1205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics