1699886259 NPI number — DR. JONATHAN ALAN PLANER MD

Table of content: DR. JONATHAN ALAN PLANER MD (NPI 1699886259)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699886259 NPI number — DR. JONATHAN ALAN PLANER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PLANER
Provider First Name:
JONATHAN
Provider Middle Name:
ALAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699886259
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3158 FREEDOM DR STE 3102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28208-0014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-971-7099
Provider Business Mailing Address Fax Number:
704-971-0035

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
920 COX RD STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GASTONIA
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28054-3435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-864-8302
Provider Business Practice Location Address Fax Number:
704-971-0035
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  2006-01032 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 566000156 . This is a "NE INPATIENT TAX ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7268818 . This is a "PROVIDER ID AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 143MJ . This is a "PROVIDER ID BCBSNC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5905006 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1427617 . This is a "PROVIDER CIGNA HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 191793 . This is a "PROVIDER ID MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8080649 . This is a "PROVIDER PARTNERS MCR CH" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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