Basic Information
| Provider Information | |||||||||
| NPI: | 1275654014 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PRITT | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4500 W NEWBERRY RD | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326072245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523366000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4500 W NEWBERRY RD | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326072245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523366000 | ||||||||
| FaxNumber: | 3525483294 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2007 | ||||||||
| LastUpdateDate: | 02/19/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 49839 | MN | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0005X | ME112924 | FL | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 687187000 | 05 | MN | MEDICAID |