Provider Demographics
NPI:1609014117
Name:JONES, JOHN W (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:JONES
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 E YOUNG
Mailing Address - Street 2:HOPE WELLNESS CENTER
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-4406
Mailing Address - Country:US
Mailing Address - Phone:208-235-4673
Mailing Address - Fax:208-441-4601
Practice Address - Street 1:1017 E YOUNG
Practice Address - Street 2:HOPE WELLNESS CENTER
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4406
Practice Address - Country:US
Practice Address - Phone:208-235-4673
Practice Address - Fax:208-441-4601
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-22
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM77012083X0100X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDB58639Medicare UPIN