Provider Demographics
NPI:1114926102
Name:JONES, ALLEN W JR (MD)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:W
Last Name:JONES
Suffix:JR
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 1:1224 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-2338
Mailing Address - Country:US
Mailing Address - Phone:406-375-4823
Mailing Address - Fax:406-375-4846
Practice Address - Street 1:1200 WESTWOOD DR
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2345
Practice Address - Country:US
Practice Address - Phone:406-363-5101
Practice Address - Fax:406-363-7652
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT26631207Q00000X
GA032214207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009915610Medicaid
GA00403103CMedicaid
MT1114926102Medicaid
GA396825OtherBC/BS GEORGIA
GAD74290Medicare UPIN
AL009915610Medicaid
GA08BBSNLMedicare PIN
GA396825OtherBC/BS GEORGIA