Individual
DR. JONATHAN MARK LAURITSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
4708 ALLIANCE BLVD STE 550, PLANO, TX 75093-5363
(469) 800-6780
(469) 800-6825
Mailing address
4708 ALLIANCE BLVD STE 550, PLANO, TX 75093-5363
(469) 800-6780
(469) 800-6825
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
S4517
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1346773017
—
TX
Enumeration date
04/09/2017
Last updated
07/05/2023
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