Basic Information
| Provider Information | |||||||||
| NPI: | 1578655866 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | GEOFFRY | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 714 W PINE ST | ||||||||
| Address2: | |||||||||
| City: | NEWPORT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 991569046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094472441 | ||||||||
| FaxNumber: | 5094470456 | ||||||||
| Practice Location | |||||||||
| Address1: | 714 W PINE ST | ||||||||
| Address2: | |||||||||
| City: | NEWPORT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 991569046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094472441 | ||||||||
| FaxNumber: | 5094470456 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 06/02/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD00036373 | WA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | MD00036373 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 806529200 | 05 | ID | MEDICAID | 8345282 | 05 | WA | MEDICAID |