Provider Demographics
NPI:1083643464
Name:JONES, STEWART OWEN (DPM)
Entity Type:Individual
Prefix:DR
First Name:STEWART
Middle Name:OWEN
Last Name:JONES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 45128
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83711-5128
Mailing Address - Country:US
Mailing Address - Phone:208-404-2262
Mailing Address - Fax:207-947-3465
Practice Address - Street 1:408 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HAILEY
Practice Address - State:ID
Practice Address - Zip Code:83333-8896
Practice Address - Country:US
Practice Address - Phone:208-404-2262
Practice Address - Fax:207-947-3465
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDP161213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805793600Medicaid
IDU76658Medicare UPIN