Provider Demographics
NPI:1033196035
Name:JONES, FREDERICK D III (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:D
Last Name:JONES
Suffix:III
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 1:5100 POPLAR AVE STE 2722
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38137-4000
Mailing Address - Country:US
Mailing Address - Phone:281-795-5891
Mailing Address - Fax:
Practice Address - Street 1:5100 POPLAR AVE STE 2722
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38137-4000
Practice Address - Country:US
Practice Address - Phone:281-795-5891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2022-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16212207L00000X
TN36366207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00120262Medicaid
MS00120262Medicaid