Provider Demographics
NPI:1659399723
Name:JONES, PHILLIP EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:EDWARD
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 1:1200 N GLOSTER ST
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-1206
Mailing Address - Country:US
Mailing Address - Phone:662-840-0990
Mailing Address - Fax:662-840-0182
Practice Address - Street 1:1200 N GLOSTER ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-1206
Practice Address - Country:US
Practice Address - Phone:662-840-0990
Practice Address - Fax:662-840-0182
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12788207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS3191589OtherCIGNA
MS09015894Medicaid
MS00015920Medicaid
MS5153241OtherAETNA
MS5153241OtherAETNA
MS080136332Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MSC68910Medicare UPIN