Provider Demographics
NPI:1225066541
Name:JONES, JOSEPH BENNETT (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:BENNETT
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:PO BOX 469
Mailing Address - Street 2:
Mailing Address - City:THORNDALE
Mailing Address - State:TX
Mailing Address - Zip Code:76577-0469
Mailing Address - Country:US
Mailing Address - Phone:512-446-2108
Mailing Address - Fax:
Practice Address - Street 1:11410 COUNTY ROAD 311
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:TX
Practice Address - Zip Code:77836
Practice Address - Country:US
Practice Address - Phone:512-446-2108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5230207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1391617180Medicaid
TX139161717Medicaid
TX139161716Medicaid
TX8B6076Medicare ID - Type Unspecified
TXC17591Medicare UPIN
TX139161716Medicaid
TX139161717Medicaid