Provider Demographics
NPI:1518258383
Name:JONES, TERESA WIESE (MD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:WIESE
Last Name:JONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:TERESA
Other - Middle Name:
Other - Last Name:STOFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-6770
Mailing Address - Fax:505-923-5354
Practice Address - Street 1:1110 YANKEE DOODLE RD
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-2092
Practice Address - Country:US
Practice Address - Phone:651-454-3970
Practice Address - Fax:651-241-0059
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2019-0076207Q00000X
MN55930207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine