Provider Demographics
NPI:1508159989
Name:JONES, GERALD DEAN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:DEAN
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 1:4755 W ANN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-3424
Mailing Address - Country:US
Mailing Address - Phone:702-396-2857
Mailing Address - Fax:
Practice Address - Street 1:4755 W ANN RD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-3424
Practice Address - Country:US
Practice Address - Phone:702-396-2857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-18
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1256363A00000X
NVNV1256363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV35664OtherMEDICARE GROUP PTAN
NVV35664OtherMEDICARE GROUP PTAN
NVFB250ZMedicare PIN
NVV35664OtherMEDICARE GROUP PTAN
AZP01078115OtherRR MEDICARE INDIV. PTAN
AZZ146133Medicare PIN