Provider Demographics
NPI:1114927019
Name:JONES, TYLER NOEL (MD)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:NOEL
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 1:304 W HAY ST
Mailing Address - Street 2:STE 111
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-6328
Mailing Address - Country:US
Mailing Address - Phone:217-872-8205
Mailing Address - Fax:217-872-5485
Practice Address - Street 1:304 W HAY ST
Practice Address - Street 2:STE 111
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-6328
Practice Address - Country:US
Practice Address - Phone:217-872-8205
Practice Address - Fax:217-872-5485
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036107301207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5574560001OtherMEDICARE DME
IL036107301Medicaid
IL483094OtherHEALTHLINK
ILP00273353OtherRAILROAD MEDICARE
IL005832071OtherBLUE CROSS BLUE SHIELD
IL483094OtherHEALTHLINK
IL5574560001OtherMEDICARE DME