Provider Demographics
NPI:1417928631
Name:JONES, DAVID ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ROBERT
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 1:4067 TRANSPORT ST # B
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-4914
Mailing Address - Country:US
Mailing Address - Phone:650-384-0986
Mailing Address - Fax:650-251-9119
Practice Address - Street 1:4067 TRANSPORT ST # B
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-4914
Practice Address - Country:US
Practice Address - Phone:650-384-0986
Practice Address - Fax:650-251-9119
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78038207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6502236Medicaid
CA00A780380Medicare PIN
CAH88160Medicare UPIN
CAP00155315Medicare ID - Type UnspecifiedRAILROAD MEDICARE
CAA78038Medicare ID - Type UnspecifiedSOUTHERN CALIFORNIA