Basic Information
| Provider Information | |||||||||
| NPI: | 1376557967 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHARLES JONES MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4743 ARAPAHOE AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BOULDER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 803031113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034432123 | ||||||||
| FaxNumber: | 3034439497 | ||||||||
| Practice Location | |||||||||
| Address1: | 4743 ARAPAHOE AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BOULDER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 803031113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034432123 | ||||||||
| FaxNumber: | 3034439497 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2006 | ||||||||
| LastUpdateDate: | 11/18/2015 | ||||||||
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| AuthorizedOfficialLastName: | JONES | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | GRAHAM | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3034432123 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD PA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 01198456 | 05 | CO | MEDICAID | 04012605 | 05 | CO | MEDICAID |