Provider Demographics
NPI:1275537235
Name:JONES, MICHAEL LLOYD (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LLOYD
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 1:1307 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-3343
Mailing Address - Country:US
Mailing Address - Phone:307-682-4664
Mailing Address - Fax:307-682-6834
Practice Address - Street 1:1307 W 3RD ST
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-3335
Practice Address - Country:US
Practice Address - Phone:307-682-4664
Practice Address - Fax:307-682-6834
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY7921A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX104197202Medicaid
TX84V186Medicare Oscar/Certification
TX104197202Medicaid