Provider Demographics
NPI:1023043908
Name:JONES, JENNIFER LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:JONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:VOGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:330 N 8TH AVE E
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2024
Mailing Address - Country:US
Mailing Address - Phone:221-872-3111
Mailing Address - Fax:218-529-9120
Practice Address - Street 1:330 N 8TH AVE E
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-2024
Practice Address - Country:US
Practice Address - Phone:221-872-3111
Practice Address - Fax:218-529-9120
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN48152207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1023043905OtherBCBS
MN588652000Medicaid
P01172468OtherRR MEDICARE
MN1023043908Medicaid
WI1023043908Medicaid
MN1023043905OtherMEDICA
1023043908OtherSECURITY HEALTH
1023043908OtherSECURITY HEALTH
MNI40635Medicare UPIN
MN588652000Medicaid
WI1023043908Medicaid