Provider Demographics
NPI:1184193971
Name:JONES, MICHAEL JON
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JON
Last Name:JONES
Suffix:
Gender:M
Credentials:
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 256
Mailing Address - Street 2:
Mailing Address - City:KOTZEBUE
Mailing Address - State:AK
Mailing Address - Zip Code:99752-0256
Mailing Address - Country:US
Mailing Address - Phone:907-442-7640
Mailing Address - Fax:
Practice Address - Street 1:23 MAIN STREET
Practice Address - Street 2:
Practice Address - City:DEERING
Practice Address - State:AK
Practice Address - Zip Code:99736
Practice Address - Country:US
Practice Address - Phone:907-363-2137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-21
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker