Provider Demographics
NPI:1710047212
Name:JONES, DAN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:MICHAEL
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 1:1111 12TH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-4084
Mailing Address - Country:US
Mailing Address - Phone:305-295-0770
Mailing Address - Fax:305-295-7225
Practice Address - Street 1:1111 12TH ST STE 103
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4084
Practice Address - Country:US
Practice Address - Phone:305-295-0770
Practice Address - Fax:305-295-7225
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85086174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist