Basic Information
| Provider Information | |||||||||
| NPI: | 1780853879 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | J FREDERICK JONES MD PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 504753 | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631500001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6608265960 | ||||||||
| FaxNumber: | 6608264852 | ||||||||
| Practice Location | |||||||||
| Address1: | 1111 N LEE AVE | ||||||||
| Address2: | SUITE 236 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731032600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4055244105 | ||||||||
| FaxNumber: | 4052350738 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2008 | ||||||||
| LastUpdateDate: | 09/22/2009 | ||||||||
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| AuthorizedOfficialLastName: | JONES | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | FREDERICK | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4052729644 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 611572700 | 01 | OK | DEPT OF LABOR | OTHER | DE5067 | 01 | OK | RR MEDICARE | OTHER | 200081281A | 05 | OK | MEDICAID |