Provider Demographics
NPI:1760478838
Name:JONES, CARL R (DO)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:R
Last Name:JONES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 RUSSELL BLVD
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-1244
Mailing Address - Country:US
Mailing Address - Phone:936-569-2000
Mailing Address - Fax:936-569-2002
Practice Address - Street 1:522 RUSSELL BLVD
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1244
Practice Address - Country:US
Practice Address - Phone:936-569-2000
Practice Address - Fax:936-569-2002
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP2129207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB159073Medicare PIN
TXTXB159072Medicare UPIN