Provider Demographics
NPI:1336323757
Name:JONES, JEROME T
Entity Type:Individual
Prefix:MR
First Name:JEROME
Middle Name:T
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1461 25TH ST SE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56304-9500
Mailing Address - Country:US
Mailing Address - Phone:320-282-1809
Mailing Address - Fax:320-230-2042
Practice Address - Street 1:1461 25TH ST SE
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56304-9500
Practice Address - Country:US
Practice Address - Phone:320-282-1809
Practice Address - Fax:320-230-2042
Is Sole Proprietor?:No
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications