Provider Demographics
NPI:1639163405
Name:JONES, DAVID EDWARD (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EDWARD
Last Name:JONES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:EDWARD
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:6625 LYNDALE AVE S STE 300
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-2491
Mailing Address - Country:US
Mailing Address - Phone:612-788-8778
Mailing Address - Fax:612-869-3473
Practice Address - Street 1:6625 LYNDALE AVE S STE 105
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-2673
Practice Address - Country:US
Practice Address - Phone:612-243-8999
Practice Address - Fax:612-869-3473
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002093213E00000X
NY3327213ES0103X
MN553213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0490900Medicaid
MNP00923858OtherMEDICARE RAIL ROAD
OH000000492694OtherANTHEM PIN
OH34200774700OtherBUREAU OF WORKERS COMPENS
OH34200774700OtherBUREAU OF WORKERS COMPENS
OH34200774700OtherBUREAU OF WORKERS COMPENS
OHP00440814Medicare PIN
OH4099602Medicare PIN
OH4099601Medicare PIN
MNP00923858OtherMEDICARE RAIL ROAD
OH000000492694OtherANTHEM PIN