1649663857 NPI number — DAVID R JONES M.D.,P.A.

Table of content: (NPI 1649663857)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649663857 NPI number — DAVID R JONES M.D.,P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID R JONES M.D.,P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1649663857
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3070 COLLEGE ST
Provider Second Line Business Mailing Address:
SUITE 406
Provider Business Mailing Address City Name:
BEAUMONT
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77701-4691
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-883-5300
Provider Business Mailing Address Fax Number:
409-883-5394

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3070 COLLEGE ST
Provider Second Line Business Practice Location Address:
SUITE 406
Provider Business Practice Location Address City Name:
BEAUMONT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77701-4691
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-883-5300
Provider Business Practice Location Address Fax Number:
409-883-5394
Provider Enumeration Date:
03/12/2015

Additional Information

Authorized Official

Authorized Official Last Name:
HAIRSTON
Authorized Official First Name:
ROSE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
409-883-5300

Provider Taxonomy Codes

  • Taxonomy code: 2081S0010X , with the licence number:  J4239 , 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: TXB146780 . This is a "MEDICARE INDIVIDUAL PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: TXB146779 . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 6742360002 . This is a "DME PTAN BEAUMONT" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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