Provider Demographics
NPI:1073543203
Name:JONES, DOUGLAS R (DO)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:R
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 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-384-2167
Mailing Address - Fax:740-446-5073
Practice Address - Street 1:140 JENKINS MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:WELLSTON
Practice Address - State:OH
Practice Address - Zip Code:45692-9561
Practice Address - Country:US
Practice Address - Phone:740-384-2167
Practice Address - Fax:740-446-5073
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.003365207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000258214OtherANTHEM (BLUE CROSS)
OH0551219Medicaid
WV3810023653Medicaid
OH4264758OtherAETNA
WV3810023653Medicaid
OH0551219Medicaid