Provider Demographics
NPI:1659395630
Name:JONES, LAURA (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:JONES
Suffix:
Gender:F
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:PO BOX 1795
Mailing Address - Street 2:
Mailing Address - City:CLEWISTON
Mailing Address - State:FL
Mailing Address - Zip Code:33440-1795
Mailing Address - Country:US
Mailing Address - Phone:863-983-2282
Mailing Address - Fax:863-983-2864
Practice Address - Street 1:115 S GLORIA ST
Practice Address - Street 2:
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440-3505
Practice Address - Country:US
Practice Address - Phone:863-983-2282
Practice Address - Fax:863-983-2864
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL73971207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257163300Medicaid
FLG64628Medicare UPIN
FL257163300Medicaid