Provider Demographics
NPI:1780978700
Name:TREECE, JONATHAN MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:MICHAEL
Last Name:TREECE
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 1:109 W KNAPP AVE
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:FL
Mailing Address - Zip Code:32132-1555
Mailing Address - Country:US
Mailing Address - Phone:386-957-4100
Mailing Address - Fax:386-957-4104
Practice Address - Street 1:109 W KNAPP AVE
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:FL
Practice Address - Zip Code:32132-1555
Practice Address - Country:US
Practice Address - Phone:386-957-4100
Practice Address - Fax:386-957-4104
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME113878207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLTRN16248OtherFLORIDA BOARD OF MEDICINE