Provider Demographics
NPI:1376718890
Name:JONES, DANIEL STEVENSON (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:STEVENSON
Last Name:JONES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9850 GENESEE AVE STE 780
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1232
Mailing Address - Country:US
Mailing Address - Phone:858-625-7200
Mailing Address - Fax:858-625-8363
Practice Address - Street 1:9850 GENESEE AVE STE 780
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1232
Practice Address - Country:US
Practice Address - Phone:858-625-7200
Practice Address - Fax:858-625-8363
Is Sole Proprietor?:No
Enumeration Date:2008-04-25
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA102945207R00000X
NY267863207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CD498ZMedicare PIN