Provider Demographics
NPI:1477754919
Name:JONES, DEREK W, (DO)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:W,
Last Name:JONES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1101 SAINT CHRISTOPHER DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7087
Mailing Address - Country:US
Mailing Address - Phone:606-836-3196
Mailing Address - Fax:606-836-2564
Practice Address - Street 1:1101 SAINT CHRISTOPHER DR
Practice Address - Street 2:SUITE 250
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7087
Practice Address - Country:US
Practice Address - Phone:606-836-3196
Practice Address - Fax:606-836-2564
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2013-07-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY03203207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100092610Medicaid
KY000000623843OtherANTHEM BCBS
KYP00754288OtherRR MEDICARE
OH2973242Medicaid
K021202Medicare PIN
KY000000623843OtherANTHEM BCBS
OH2973242Medicaid