Provider Demographics
NPI:1083023212
Name:JONES, CODY DANIEL (SUBMARINE IDC)
Entity Type:Individual
Prefix:MR
First Name:CODY
Middle Name:DANIEL
Last Name:JONES
Suffix:
Gender:M
Credentials:SUBMARINE IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 ELDER AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-3756
Mailing Address - Country:US
Mailing Address - Phone:774-488-4407
Mailing Address - Fax:
Practice Address - Street 1:112 ELDER AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915-3756
Practice Address - Country:US
Practice Address - Phone:774-488-4407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-13
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman