Provider Demographics
NPI:1609979681
Name:JONES, DAVID LANE (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LANE
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 1:1370 MAYFLOWER AVE
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-6723
Mailing Address - Country:US
Mailing Address - Phone:321-259-5655
Mailing Address - Fax:
Practice Address - Street 1:1370 MAYFLOWER AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-6723
Practice Address - Country:US
Practice Address - Phone:321-259-5655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6830207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMH3451Medicaid
320070Medicare ID - Type Unspecified
NMH3451Medicaid