Provider Demographics
NPI:1114672649
Name:JONES, JASON T
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:T
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2363 MAYFAIR RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-2943
Mailing Address - Country:US
Mailing Address - Phone:937-286-0543
Mailing Address - Fax:
Practice Address - Street 1:2363 MAYFAIR RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-2943
Practice Address - Country:US
Practice Address - Phone:937-286-0543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver