Basic Information
| Provider Information | |||||||||
| NPI: | 1558317644 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JONASON | ||||||||
| FirstName: | NEIL | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1027 WASHINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | DETROIT LAKES | ||||||||
| State: | MN | ||||||||
| PostalCode: | 565013409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2188475611 | ||||||||
| FaxNumber: | 2188470881 | ||||||||
| Practice Location | |||||||||
| Address1: | 1027 WASHINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | DETROIT LAKES | ||||||||
| State: | MN | ||||||||
| PostalCode: | 565013409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2188475611 | ||||||||
| FaxNumber: | 2188470881 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 11/22/2011 | ||||||||
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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 | 207Q00000X | 26966 | MN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0106050 | 01 | MN | MEDICA # | OTHER | 116791 | 01 | MN | UCARE # | OTHER | DA9031015652 | 01 | MN | PREFERRED ONE # | OTHER | HP19548 | 01 | MN | HEALTHPARTNERS # | OTHER | 0106048 | 01 | MN | MEDICA # | OTHER | 16653 | 05 | MN | MEDICAID | 2367 | 01 | MN | SIOUX VALLEY # | OTHER | 6469 | 01 | MN | NDBS # | OTHER | 911325 | 01 | MN | AMERICA'S PPO/ARAZ # | OTHER | 054063300 | 05 | MN | MEDICAID | 24325JO | 01 | MN | MNBS # | OTHER | 6465 | 01 | MN | NDBS # | OTHER | MN100023 | 01 | MN | LHS/BANNERHEALTH # | OTHER |