Provider Demographics
NPI:1407104482
Name:JONES, GARY MOSHER (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:MOSHER
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 1:2004 RIDING RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-6713
Mailing Address - Country:US
Mailing Address - Phone:803-788-2302
Mailing Address - Fax:803-788-2302
Practice Address - Street 1:2004 RIDING RIDGE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-6713
Practice Address - Country:US
Practice Address - Phone:803-788-2302
Practice Address - Fax:803-788-2302
Is Sole Proprietor?:No
Enumeration Date:2012-08-22
Last Update Date:2012-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC007735208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD99928Medicare UPIN