Provider Demographics
NPI:1063462380
Name:JONES, PHILLIP WAYNE (DO)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:WAYNE
Last Name:JONES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2149 SW 59TH ST
Mailing Address - Street 2:SUITE NO. 203
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73119-7033
Mailing Address - Country:US
Mailing Address - Phone:405-445-3025
Mailing Address - Fax:405-445-3807
Practice Address - Street 1:2149 SW 59TH ST
Practice Address - Street 2:SUITE NO. 203
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73119-7033
Practice Address - Country:US
Practice Address - Phone:405-445-3025
Practice Address - Fax:405-445-3807
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3899207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H67448Medicare UPIN
248227102Medicare ID - Type Unspecified