Provider Demographics
NPI:1699808683
Name:JONES, ANDREW EDWIN (IDC)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:EDWIN
Last Name:JONES
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 557, BOX 224
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96379
Mailing Address - Country:US
Mailing Address - Phone:01181611-746-5366
Mailing Address - Fax:01181611-746-2341
Practice Address - Street 1:PSC 557, BOX 224
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96379
Practice Address - Country:US
Practice Address - Phone:01181611-745-6102
Practice Address - Fax:01181611-745-2341
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1710I1002X1710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman