Provider Demographics
NPI:1750323978
Name:JONES, DAVID J (PAC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:J
Last Name:JONES
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 S BEACH ST APT 214A
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-5404
Mailing Address - Country:US
Mailing Address - Phone:727-859-6125
Mailing Address - Fax:
Practice Address - Street 1:721 S BEACH ST APT 214A
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-5404
Practice Address - Country:US
Practice Address - Phone:727-859-6125
Practice Address - Fax:727-859-6125
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA3156363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC101764OtherNC LICENSE NUMBER
FLE0613PMedicare PIN
554165Medicare UPIN
FLE0613NMedicare PIN
NC101764OtherNC LICENSE NUMBER