1720063282 NPI number — MR. BRIAN DAVID JONES MPT

Table of content: MR. BRIAN DAVID JONES MPT (NPI 1720063282)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720063282 NPI number — MR. BRIAN DAVID JONES MPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
BRIAN
Provider Middle Name:
DAVID
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MPT
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:
1720063282
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
980 S WATSON RD STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUCKEYE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85326-3433
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-289-1916
Provider Business Mailing Address Fax Number:
623-289-1916

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
980 S WATSON RD STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUCKEYE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85326-3433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-289-1916
Provider Business Practice Location Address Fax Number:
623-289-1916
Provider Enumeration Date:
12/07/2005

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: 225100000X , with the licence number:  10157 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: PT-012616L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: LPT-008464 , 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: 5550830001 . This is a "MEDICARE NSC SCW" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 5550830004 . This is a "MEDICARE NSC PV" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 5550830006 . This is a "MEDICARE NSC ANTHEM" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 5550830003 . This is a "MEDICARE NSC PEORIA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 5550830009 . This is a "MEDICARE NSC AZ NORTH" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 5550830008 . This is a "MEDICARE NSC SWV" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 433109 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5550830007 . This is a "MEDICARE NSC DV" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 5550830010 . This is a "MEDICARE NSC GILBERT" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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