Provider Demographics
NPI:1578726451
Name:JONES, JONATHAN EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:EDWARD
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 1:6428 W HIGHWAY 98
Mailing Address - Street 2:
Mailing Address - City:PORT ST JOE
Mailing Address - State:FL
Mailing Address - Zip Code:32456-7401
Mailing Address - Country:US
Mailing Address - Phone:800-272-2707
Mailing Address - Fax:800-936-4562
Practice Address - Street 1:6428 W HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:PORT ST JOE
Practice Address - State:FL
Practice Address - Zip Code:32456-7401
Practice Address - Country:US
Practice Address - Phone:800-272-2707
Practice Address - Fax:800-936-4562
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME108942207P00000X
OH35.136057207P00000X
TXS0469207P00000X
GA82751207P00000X
ALMD.38288207P00000X
KY43589207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000753841OtherBCBS
KY7100107910Medicaid
KY7100107910Medicaid