Individual
MR. JONATHAN DEAN MEDECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
710 SAINT ANNE STREET, RAPID CITY, SD 57701-4670
(605) 343-8000
(605) 343-8262
Mailing address
PO BOX 3468, RAPID CITY, SD 57709-3468
(605) 343-8000
(605) 343-8262
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
0361
SD
363A00000X
Physician Assistant
Primary
0361
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070013292
RAILROAD MEDICARE
SD
05
—
6826630
—
SD
Enumeration date
02/15/2006
Last updated
03/02/2018
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