Individual
JONATHAN ANTHONY SHOMO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0110002842
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1689822652
—
VA
Enumeration date
09/03/2008
Last updated
08/19/2021
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