Provider Demographics
NPI:1730400540
Name:DEGROAT, JONATHAN THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:THOMAS
Last Name:DEGROAT
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 1:6531 CHANNELSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-2061
Mailing Address - Country:US
Mailing Address - Phone:941-725-1868
Mailing Address - Fax:
Practice Address - Street 1:6531 CHANNELSIDE DR
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-2061
Practice Address - Country:US
Practice Address - Phone:941-725-1868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2014-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME114356207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009326800Medicaid
FLHL652YMedicare PIN