Provider Demographics
NPI:1124004510
Name:JONES, STEPHEN DONALD (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:DONALD
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 1:3340 E GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642
Mailing Address - Country:US
Mailing Address - Phone:208-302-0130
Mailing Address - Fax:208-302-0135
Practice Address - Street 1:6140 W CURTISIAN AVE
Practice Address - Street 2:STE 102
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704
Practice Address - Country:US
Practice Address - Phone:208-302-0130
Practice Address - Fax:208-302-0135
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5013208G00000X
IDM-11141208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000WFBKKOtherMEDICARE GROUP NUMBER
AKMD2257Medicaid
P00152278OtherRAILROAD MEDICARE
AKMD2257Medicaid
0000WFBKKOtherMEDICARE GROUP NUMBER