Provider Demographics
NPI:1023183308
Name:JONES, HUMPHREY C (MD)
Entity Type:Individual
Prefix:
First Name:HUMPHREY
Middle Name:C
Last Name:JONES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 NW 95TH ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33150-2063
Mailing Address - Country:US
Mailing Address - Phone:305-694-1374
Mailing Address - Fax:305-694-1376
Practice Address - Street 1:1190 NW 95TH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33150-2063
Practice Address - Country:US
Practice Address - Phone:305-694-1374
Practice Address - Fax:305-694-1376
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 290132086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD58607Medicare UPIN
FL79000Medicare ID - Type Unspecified