Provider Demographics
NPI:1235297466
Name:JONES, JACK GORDON (MEDICAL DOCTOR)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:GORDON
Last Name:JONES
Suffix:
Gender:M
Credentials:MEDICAL DOCTOR
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1660 AKRON PENINSULA RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-5189
Mailing Address - Country:US
Mailing Address - Phone:330-920-1660
Mailing Address - Fax:330-920-1373
Practice Address - Street 1:1660 AKRON PENINSULA RD
Practice Address - Street 2:SUITE 101
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-5189
Practice Address - Country:US
Practice Address - Phone:330-920-1660
Practice Address - Fax:330-920-1373
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH38061173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHJO 0451356OtherMEDICARE PROVIDER NUMBER
OH34 1256234-00OtherOH. BUREAU OF WORKER'S CO
OH34 1256234-0001OtherCOMMUNITY MUTUAL BCBS
OH341256234-001OtherBCBS OF OHIO
OHBJ9543617OtherDRUG ENFORCEMENT AGENCY