Provider Demographics
NPI:1154837748
Name:JONES, JIMUEL W (LD)
Entity Type:Individual
Prefix:
First Name:JIMUEL
Middle Name:W
Last Name:JONES
Suffix:
Gender:M
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4815 FM 2351 RD STE 209
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-2830
Mailing Address - Country:US
Mailing Address - Phone:346-803-1821
Mailing Address - Fax:
Practice Address - Street 1:4815 FM 2351 RD STE 209
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-2830
Practice Address - Country:US
Practice Address - Phone:346-803-1821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-19
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1154837748207ZC0006X, 247ZC0005X
TX246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician
No207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX$$$$$$$$$Medicaid