Provider Demographics
NPI:1679803977
Name:COLL, JONATHAN PATRICK (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:PATRICK
Last Name:COLL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 W PEDREGOSA ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-4622
Mailing Address - Country:US
Mailing Address - Phone:805-708-7976
Mailing Address - Fax:
Practice Address - Street 1:902 W PEDREGOSA ST
Practice Address - Street 2:APT A
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-4622
Practice Address - Country:US
Practice Address - Phone:805-708-7976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-08
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA981532085B0100X
NJ25MA093691002085R0202X
AZ463442085R0202X
PAMD4476782085R0202X
CAA 981532085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging