Provider Demographics
NPI:1639139793
Name:JONES, EDWARD DUANE (MD)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:DUANE
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 1:5701 N. PORTLAND, SUITE 105
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-1670
Mailing Address - Country:US
Mailing Address - Phone:405-949-6401
Mailing Address - Fax:405-946-4283
Practice Address - Street 1:5701 N. PORTLAND, SUITE 105
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-1670
Practice Address - Country:US
Practice Address - Phone:405-949-6401
Practice Address - Fax:405-946-4283
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18051207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKF45441Medicare UPIN