Provider Demographics
NPI:1083676886
Name:JONES, PHILLIP (MD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
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 1:514 S BONHAM ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:MEXIA
Mailing Address - State:TX
Mailing Address - Zip Code:76667-3600
Mailing Address - Country:US
Mailing Address - Phone:254-562-5961
Mailing Address - Fax:254-562-2813
Practice Address - Street 1:514 S BONHAM ST
Practice Address - Street 2:SUITE G
Practice Address - City:MEXIA
Practice Address - State:TX
Practice Address - Zip Code:76667-3600
Practice Address - Country:US
Practice Address - Phone:254-562-5961
Practice Address - Fax:254-562-2813
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5232208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114866007Medicaid
TX8S0928OtherBLUE CROSS
TXD66677Medicare UPIN
TX114866007Medicaid
TXP00264830Medicare PIN