Provider Demographics
NPI:1326048778
Name:JONES, RENEE L (MD)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:L
Last Name:JONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 E. PLEASANT VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-5530
Mailing Address - Country:US
Mailing Address - Phone:814-946-0821
Mailing Address - Fax:814-941-2520
Practice Address - Street 1:600 E. PLEASANT VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-5530
Practice Address - Country:US
Practice Address - Phone:814-946-0821
Practice Address - Fax:814-941-2520
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD066973L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0075112190002Medicaid
PA7511219Medicaid
PA0075112190002Medicaid
025369Medicare ID - Type Unspecified