Basic Information
| Provider Information | |||||||||
| NPI: | 1811190176 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | BOOTH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | II | ||||||||
| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | JONES | ||||||||
| OtherFirstName: | DAN | ||||||||
| OtherMiddleName: | B | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | DO | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 72562 STATE ROUTE 250 | ||||||||
| Address2: | |||||||||
| City: | DILLIONVALE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407380020 | ||||||||
| FaxNumber: | 7407380625 | ||||||||
| Practice Location | |||||||||
| Address1: | 72562 STATE ROUTE 250 | ||||||||
| Address2: | |||||||||
| City: | DILLIONVALE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407380020 | ||||||||
| FaxNumber: | 7407380625 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2007 | ||||||||
| LastUpdateDate: | 04/06/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 04/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2254 | WV | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 34.009232 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2976212 | 05 | OH | MEDICAID |