Basic Information
| Provider Information | |||||||||
| NPI: | 1679811210 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MATTHEW S. JONES | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | WALTER D. JONES | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8525 GIBBS DR | ||||||||
| Address2: | SUITE 208 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921231755 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8584950971 | ||||||||
| FaxNumber: | 8584950991 | ||||||||
| Practice Location | |||||||||
| Address1: | 7485 MISSION VALLEY RD | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921084422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192913737 | ||||||||
| FaxNumber: | 6192208973 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2013 | ||||||||
| LastUpdateDate: | 01/16/2013 | ||||||||
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| AuthorizedOfficialLastName: | JONES | ||||||||
| AuthorizedOfficialFirstName: | MATTHEW | ||||||||
| AuthorizedOfficialMiddleName: | SCOTT | ||||||||
| AuthorizedOfficialTitleorPosition: | MD | ||||||||
| AuthorizedOfficialTelephone: | 8584950971 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | C41234 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 00C412341 | 05 | CA | MEDICAID |