Individual
JONATHAN LEE GLEASON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
101 HALTON VILLAGE CIR, GREENVILLE, SC 29607-6825
(864) 455-1600
(864) 286-5298
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8603
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
MT186681
PA
207VF0040X
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
0101251665
VA
207VF0040X
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
Primary
88740
SC
207VG0400X
Gynecology Physician
0101251665
VA
207VG0400X
Gynecology Physician
29368
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02536526
—
MS
05
—
113528
—
AL
05
—
113530
—
AL
05
—
113533
—
AL
01
—
51599089
BLUE CROSS
AL
01
—
51599090
BLUE CROSS
AL
01
—
51599092
BLUE CROSS
AL
05
—
557400
—
SC
Enumeration date
12/27/2006
Last updated
05/11/2023
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