Basic Information
| Provider Information | |||||||||
| NPI: | 1861756223 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOENS | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | BRADFORD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1225 CAMPBELL WAY STE 101 | ||||||||
| Address2: | |||||||||
| City: | BREMERTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983103323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604794203 | ||||||||
| FaxNumber: | 2538391071 | ||||||||
| Practice Location | |||||||||
| Address1: | 1225 CAMPBELL WAY STE 101 | ||||||||
| Address2: | |||||||||
| City: | BREMERTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983103323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604794203 | ||||||||
| FaxNumber: | 2538391071 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2012 | ||||||||
| LastUpdateDate: | 07/20/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD60938378 | WA | N | Allopathic & Osteopathic Physicians | Surgery | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2086S0129X | MD60938378 | WA | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | 2144900 | 05 | WA | MEDICAID |