Provider Demographics
NPI:1104851997
Name:JONES, JEFFREY S (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:S
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 1:1937 MOMENTUM PL
Mailing Address - Street 2:LOCKBOX 231937
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60689-5319
Mailing Address - Country:US
Mailing Address - Phone:502-413-6994
Mailing Address - Fax:502-753-0687
Practice Address - Street 1:307 N HURSTBOURNE PKWY
Practice Address - Street 2:SUITE# 290
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-8597
Practice Address - Country:US
Practice Address - Phone:502-413-6994
Practice Address - Fax:502-753-0687
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY263042085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64263049Medicaid
KY0639908Medicare ID - Type Unspecified
KYE14971Medicare UPIN
KY00057012Medicare PIN
KY1276418Medicare ID - Type Unspecified
KY64263049Medicaid