Provider Demographics
NPI:1760464630
Name:JONES, SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
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 1:1515 NW 18TH AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2515
Mailing Address - Country:US
Mailing Address - Phone:503-224-8399
Mailing Address - Fax:503-224-5661
Practice Address - Street 1:1515 NW 18TH AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2515
Practice Address - Country:US
Practice Address - Phone:503-224-8399
Practice Address - Fax:503-224-5661
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD13489207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C90986Medicare UPIN
121685Medicare ID - Type Unspecified