Provider Demographics
NPI: | 1487688867 |
---|---|
Name: | JONES, HUBERT R (PA-C) |
Entity Type: | Individual |
Prefix: | MR |
First Name: | HUBERT |
Middle Name: | R |
Last Name: | JONES |
Suffix: | |
Gender: | M |
Credentials: | PA-C |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 1617 N FRONT ST |
Mailing Address - Street 2: | |
Mailing Address - City: | HARRISBURG |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 17102-2414 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 717-236-4682 |
Mailing Address - Fax: | 717-236-2423 |
Practice Address - Street 1: | 1617 N FRONT ST |
Practice Address - Street 2: | |
Practice Address - City: | HARRISBURG |
Practice Address - State: | PA |
Practice Address - Zip Code: | 17102-2414 |
Practice Address - Country: | US |
Practice Address - Phone: | 717-236-4682 |
Practice Address - Fax: | 717-236-2423 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-07-10 |
Last Update Date: | 2023-03-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | MA000015L | 363AM0700X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PA | 0011811520001 | Medicaid | |
PA | MA000015L | Other | STATE MEDICAL LICENSE |
PA | MA000015L | Other | STATE MEDICAL LICENSE |
PA | R06761 | Medicare UPIN | |
PA | MJ0192409 | Other | DEA |