1386827244 NPI number — MATTHEW D JONES DPM

Table of content: MATTHEW D JONES DPM (NPI 1386827244)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386827244 NPI number — MATTHEW D JONES DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
MATTHEW
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386827244
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2698 E SCENIC OVERLOOK PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85739-8843
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-979-1285
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5300 E ERICKSON DR
Provider Second Line Business Practice Location Address:
SUITE 118
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85712-2828
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-326-6766
Provider Business Practice Location Address Fax Number:
520-740-1939
Provider Enumeration Date:
12/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  0666 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 440246 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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