Provider Demographics
NPI:1073291852
Name:JONES, ANTHONY Y (MMP, HE, MT)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:Y
Last Name:JONES
Suffix:
Gender:M
Credentials:MMP, HE, MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7429 MAXIMILLIAN PL
Mailing Address - Street 2:
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-3648
Mailing Address - Country:US
Mailing Address - Phone:415-684-2119
Mailing Address - Fax:
Practice Address - Street 1:7429 MAXIMILLIAN PL
Practice Address - Street 2:
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-3648
Practice Address - Country:US
Practice Address - Phone:707-770-7421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV62836204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine