1639225717 NPI number — DR. JOHN PAUL JONES PH.D.

Table of content: DR. JOHN PAUL JONES PH.D. (NPI 1639225717)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639225717 NPI number — DR. JOHN PAUL JONES PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
JOHN
Provider Middle Name:
PAUL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.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:
1639225717
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5199 GREENVIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAYLORD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49735-9550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-546-2027
Provider Business Mailing Address Fax Number:
989-732-2551

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
606 N COURT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAYLORD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49735-1516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-732-6488
Provider Business Practice Location Address Fax Number:
989-732-2551
Provider Enumeration Date:
01/25/2007

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: 103TB0200X , with the licence number:  6301003256 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 087989 . This is a "VALUE OPTIONS ID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: JJ003256 . This is a "STATE NO" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 277152000 . This is a "MAGELLAN PIN NO." identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 11255933 . This is a "CAQH ID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 680F910370 . This is a "BCBS PIN NO" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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