Provider Demographics
NPI:1073557930
Name:JONES, MICHAEL C (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
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 1:703 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-4444
Mailing Address - Country:US
Mailing Address - Phone:830-997-9507
Mailing Address - Fax:830-997-0583
Practice Address - Street 1:703 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-4444
Practice Address - Country:US
Practice Address - Phone:830-997-9507
Practice Address - Fax:830-997-0583
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4131208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126479804Medicaid
TX0616600001OtherMEDICARE PALMETTO DME #
TX340001356OtherMEDICARE RAILROAD #
TX00FP77OtherBCBS PROVIDER #
TX00FP77Medicare PIN
TXD66672Medicare UPIN