Provider Demographics
NPI:1043740418
Name:JONES, JONATHAN (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
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 1:929 RIDGE RD
Mailing Address - Street 2:STE 7
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-1769
Mailing Address - Country:US
Mailing Address - Phone:219-836-9515
Mailing Address - Fax:219-836-8547
Practice Address - Street 1:929 RIDGE RD STE 7
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-1769
Practice Address - Country:US
Practice Address - Phone:219-836-9515
Practice Address - Fax:219-836-8547
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01083277A207Q00000X
IN11019165A390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program