Provider Demographics
NPI:1275777260
Name:JONES, BRENT FOSSUM (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:FOSSUM
Last Name:JONES
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Gender:M
Credentials:MD
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Mailing Address - Street 1:788 N JEFFERSON ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-3718
Mailing Address - Country:US
Mailing Address - Phone:414-272-8950
Mailing Address - Fax:414-225-2929
Practice Address - Street 1:788 N JEFFERSON ST
Practice Address - Street 2:SUITE 201
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-3718
Practice Address - Country:US
Practice Address - Phone:414-226-4010
Practice Address - Fax:414-274-6270
Is Sole Proprietor?:No
Enumeration Date:2009-04-22
Last Update Date:2016-11-09
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Provider Licenses
StateLicense IDTaxonomies
WI63122-20207RE0101X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1275777260Medicaid
WI1275777260Medicaid
WI1275777260Medicaid