Individual
JONATHAN GRANT MONDRAGON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2401 SOUTH 31ST STREET, MS-AG-407Q, TEMPLE, TX 76508-0001
(254) 724-5815
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
(254) 724-2111
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
T0574
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/29/2018
Last updated
12/13/2022
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