Provider Demographics
NPI:1164593372
Name:JONES, WALTER III (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:
Last Name:JONES
Suffix:III
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:PO BOX 163
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-0061
Mailing Address - Country:US
Mailing Address - Phone:909-748-6569
Mailing Address - Fax:
Practice Address - Street 1:33423 YUCAIPA BLVD STE D
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-2005
Practice Address - Country:US
Practice Address - Phone:909-790-7070
Practice Address - Fax:909-790-9002
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54962207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A549620Medicaid
CA00A549620Medicaid