Provider Demographics
NPI:1760455661
Name:JONES, D'ANDRIENNE C (MD)
Entity Type:Individual
Prefix:
First Name:D'ANDRIENNE
Middle Name:C
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 1:2416 BLOOMER DRIVE
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002
Mailing Address - Country:US
Mailing Address - Phone:618-465-9500
Mailing Address - Fax:618-465-9502
Practice Address - Street 1:2416 BLOOMER DRIVE
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002
Practice Address - Country:US
Practice Address - Phone:618-465-9500
Practice Address - Fax:618-465-9502
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2011-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036105039207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0361050392Medicaid
ILK26894Medicare PIN
ILG41835Medicare UPIN