Provider Demographics
NPI:1992751200
Name:JONATHAN STEIN MD
Entity type:Organization
Organization Name:JONATHAN STEIN MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:STEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-367-1936
Mailing Address - Street 1:104 SHINNECOCK HILLS DR
Mailing Address - Street 2:
Mailing Address - City:BROUSSARD
Mailing Address - State:LA
Mailing Address - Zip Code:70518-6175
Mailing Address - Country:US
Mailing Address - Phone:337-856-1036
Mailing Address - Fax:
Practice Address - Street 1:104 SHINNECOCK HILLS DR
Practice Address - Street 2:
Practice Address - City:BROUSSARD
Practice Address - State:LA
Practice Address - Zip Code:70518-6175
Practice Address - Country:US
Practice Address - Phone:337-856-1036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1447927Medicaid
LADF2797Medicare PIN
LA1447927Medicaid