Basic Information
| Provider Information | |||||||||
| NPI: | 1063461432 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 222 ALEXANDER ST | ||||||||
| Address2: | MONROE COURT | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146074039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859228350 | ||||||||
| FaxNumber: | 5859228355 | ||||||||
| Practice Location | |||||||||
| Address1: | 222 ALEXANDER ST | ||||||||
| Address2: | MONROE COURT | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146074039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859228350 | ||||||||
| FaxNumber: | 5859228355 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 01/27/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RA0201X | 138757 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Allergy & Immunology | 207RR0500X | 138757 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | 2080P0201X | 138757 | NY | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Allergy/Immunology |
ID Information
| ID | Type | State | Issuer | Description | 03010976 | 05 | NY | MEDICAID | P00026205 | 01 | NY | RAILROAD MEDICARE | OTHER |