Basic Information
| Provider Information | |||||||||
| NPI: | 1699125260 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STODDARD | ||||||||
| FirstName: | JONATHAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 36065 SANTA FE AVE | ||||||||
| Address2: | |||||||||
| City: | FORT HOOD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 765445060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2489411515 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9300 DEWITT LOOP | ||||||||
| Address2: | |||||||||
| City: | FORT BELVOIR | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220605285 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5712311994 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2016 | ||||||||
| LastUpdateDate: | 07/31/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0116029023 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.