Provider Demographics
NPI:1154976900
Name:PIERRE-LOUIS, JONATHAN (PA)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:PIERRE-LOUIS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 E INTERSTATE HIGHWAY 2 STE 3
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-2104
Mailing Address - Country:US
Mailing Address - Phone:956-491-7450
Mailing Address - Fax:956-584-8223
Practice Address - Street 1:2310 E INTERSTATE HIGHWAY 2 STE 3
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-2104
Practice Address - Country:US
Practice Address - Phone:956-491-7450
Practice Address - Fax:956-584-8223
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR174-P.A.207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine