1396776597 NPI number — RICHARD ROBERT JONES M.D.

Table of content: RICHARD ROBERT JONES M.D. (NPI 1396776597)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396776597 NPI number — RICHARD ROBERT JONES M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
RICHARD
Provider Middle Name:
ROBERT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1396776597
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2701 W 15TH ST
Provider Second Line Business Mailing Address:
BOX 629
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75075-7523
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-612-4999
Provider Business Mailing Address Fax Number:
972-612-1555

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 COIT RD
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75075-6174
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-612-4999
Provider Business Practice Location Address Fax Number:
972-612-1555
Provider Enumeration Date:
07/05/2006

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: 208100000X , with the licence number:  H3083 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 135411006 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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