Provider Demographics
NPI:1215975503
Name:APPELBAUM, JONATHAN S (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:S
Last Name:APPELBAUM
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:FLORIDA STATE UNIVERSITY COLLEGE OF MEDICINE
Mailing Address - Street 2:1115 WEST CALL STREET, SUITE 3140-J
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32306-4300
Mailing Address - Country:US
Mailing Address - Phone:850-645-1227
Mailing Address - Fax:850-644-0158
Practice Address - Street 1:1255 W WASHINGTON ST
Practice Address - Street 2:JEFFERSON COUNTY HEALTH DEPARTMENT
Practice Address - City:MONTICELLO
Practice Address - State:FL
Practice Address - Zip Code:32344-1128
Practice Address - Country:US
Practice Address - Phone:850-342-0170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL96766207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000858900Medicaid
B98923Medicare UPIN
CS4D6ZMedicare PIN