Provider Demographics
NPI:1306807847
Name:NORCROSS, JONATHAN G (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:G
Last Name:NORCROSS
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:PO BOX 810
Mailing Address - Street 2:
Mailing Address - City:LONOKE
Mailing Address - State:AR
Mailing Address - Zip Code:72086-0810
Mailing Address - Country:US
Mailing Address - Phone:501-676-5123
Mailing Address - Fax:501-676-7475
Practice Address - Street 1:1310 N CENTER ST
Practice Address - Street 2:
Practice Address - City:LONOKE
Practice Address - State:AR
Practice Address - Zip Code:72086-2011
Practice Address - Country:US
Practice Address - Phone:501-676-5123
Practice Address - Fax:501-676-7475
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-4614207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR05100013200OtherQUALCHOICE
AR158051001Medicaid
AR7194721OtherAETNA
AR158051001Medicaid
AR5N379Medicare PIN
AR7194721OtherAETNA