Provider Demographics
NPI:1508806811
Name:JONES, SIDNEY AMOS (MD)
Entity Type:Individual
Prefix:
First Name:SIDNEY
Middle Name:AMOS
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 1:111 HUNDERTMARK RD
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-4551
Mailing Address - Country:US
Mailing Address - Phone:952-361-2450
Mailing Address - Fax:952-361-2461
Practice Address - Street 1:111 HUNDERTMARK RD STE 115N
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-1584
Practice Address - Country:US
Practice Address - Phone:952-361-2450
Practice Address - Fax:952-361-2461
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN37884207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN195127100Medicaid
MN460000217Medicare ID - Type Unspecified
MN195127100Medicaid