Provider Demographics
NPI:1477304848
Name:JONES, DEREK LEO (MD)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:LEO
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 1:355 W 16TH ST STE 4700
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-2285
Mailing Address - Country:US
Mailing Address - Phone:317-963-7408
Mailing Address - Fax:
Practice Address - Street 1:355 W 16TH ST STE 4700
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2285
Practice Address - Country:US
Practice Address - Phone:317-963-7408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program