Provider Demographics
NPI:1194102772
Name:DAMEWORTH, JONATHAN L (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:L
Last Name:DAMEWORTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 33269
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85067-3269
Mailing Address - Country:US
Mailing Address - Phone:602-406-4786
Mailing Address - Fax:916-636-4358
Practice Address - Street 1:500 W THOMAS RD STE 400
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4238
Practice Address - Country:US
Practice Address - Phone:602-406-3874
Practice Address - Fax:602-406-2335
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-02
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
AZ64001208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program