Individual
JONATHAN SO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
111 S 11TH ST, PHILADELPHIA, PA 19107-4824
(215) 955-9837
Mailing address
111 S 11TH ST, PHILADELPHIA, PA 19107-4824
(215) 955-9837
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MT197660
PA
Other
Enumeration date
07/26/2010
Last updated
07/26/2010
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