Provider Demographics
NPI:1003913468
Name:JONES, KEVIN BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:BRUCE
Last Name:JONES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 SW 26TH AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:MINERAL WELLS
Mailing Address - State:TX
Mailing Address - Zip Code:76067-8249
Mailing Address - Country:US
Mailing Address - Phone:940-325-4426
Mailing Address - Fax:940-325-7727
Practice Address - Street 1:214 SW 26TH AVE
Practice Address - Street 2:SUITE C
Practice Address - City:MINERAL WELLS
Practice Address - State:TX
Practice Address - Zip Code:76067-8249
Practice Address - Country:US
Practice Address - Phone:940-325-4426
Practice Address - Fax:940-325-7727
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5231207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX035423501Medicaid
TXC17575Medicare UPIN
TX00QD02Medicare ID - Type Unspecified