Provider Demographics
NPI:1275595811
Name:JONES, GINA L (PAC)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:L
Last Name:JONES
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 DOCTORS PARK DR
Mailing Address - Street 2:STE 200
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8198
Mailing Address - Country:US
Mailing Address - Phone:541-282-2200
Mailing Address - Fax:541-245-6049
Practice Address - Street 1:2900 DOCTORS PARK DR
Practice Address - Street 2:STE 200
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8198
Practice Address - Country:US
Practice Address - Phone:541-282-2200
Practice Address - Fax:541-245-6049
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA01039363AM0700X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR022868Medicaid