Provider Demographics
NPI:1205833688
Name:JONES, JEROME H (MD)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:H
Last Name:JONES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1665 SCENIC AVE.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626
Mailing Address - Country:US
Mailing Address - Phone:714-968-0068
Mailing Address - Fax:714-378-2188
Practice Address - Street 1:19066 MAGNOLIA ST.
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646
Practice Address - Country:US
Practice Address - Phone:714-968-0068
Practice Address - Fax:714-378-2188
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC28381208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C283810OtherMEDI CAL
CAF88088Medicare UPIN