1679663090 NPI number — MATTHEW ALLAN JONES OD

Table of content: MATTHEW ALLAN JONES OD (NPI 1679663090)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679663090 NPI number — MATTHEW ALLAN JONES OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
MATTHEW
Provider Middle Name:
ALLAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
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:
1679663090
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/11/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
124 E ROWAN AVE
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
SPOKANE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99207-1214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-484-6550
Provider Business Mailing Address Fax Number:
509-484-0082

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
124 E ROWAN AVE
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99207-1214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-484-6550
Provider Business Practice Location Address Fax Number:
509-484-0082
Provider Enumeration Date:
10/14/2006

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: 152W00000X , with the licence number:  1597 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2107902 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 86252 . This is a "LABOR AND INDUSTRY" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: DC9602 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com