Provider Demographics
NPI:1578676474
Name:JONES, MATTHEW PHILIP (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:PHILIP
Last Name:JONES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9680 TAMARACK RD STE 100
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2617
Mailing Address - Country:US
Mailing Address - Phone:651-738-0470
Mailing Address - Fax:952-278-6947
Practice Address - Street 1:9680 TAMARACK RD STE 100
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2617
Practice Address - Country:US
Practice Address - Phone:651-738-0470
Practice Address - Fax:952-278-6947
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN35275208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNFP9020802027OtherPREFERRED ONE
MN3D847JOOtherBC/BS
MN1225054OtherMEDICA
MN897703800Medicaid