Basic Information
Provider Information
NPI: 1821031345
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JONES
FirstName: JEFFREY
MiddleName: T.
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
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Mailing Information
Address1: 2817 MCCLELLAND BLVD
Address2: SUITE 52
City: JOPLIN
State: MO
PostalCode: 648041629
CountryCode: US
TelephoneNumber: 4176236056
FaxNumber: 4176278331
Practice Location
Address1: 2631 CUNNINGHAM AVE
Address2: SUITE A
City: JOPLIN
State: MO
PostalCode: 648041543
CountryCode: US
TelephoneNumber: 4176278967
FaxNumber: 4176278951
Other Information
ProviderEnumerationDate: 06/13/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000XR2H66MOY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


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