Provider Demographics
NPI:1376557967
Name:CHARLES JONES MD PC
Entity Type:Organization
Organization Name:CHARLES JONES MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:GRAHAM
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:303-443-2123
Mailing Address - Street 1:4743 ARAPAHOE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-1113
Mailing Address - Country:US
Mailing Address - Phone:303-443-2123
Mailing Address - Fax:303-443-9497
Practice Address - Street 1:4743 ARAPAHOE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1113
Practice Address - Country:US
Practice Address - Phone:303-443-2123
Practice Address - Fax:303-443-9497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01198456Medicaid
CO04012605Medicaid
CO04012605Medicaid
COCE6208Medicare PIN