Provider Demographics
NPI:1790757334
Name:JONES, JOHN D (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:JONES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1628 MEDICAL ARTS BLVD
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46011-3441
Mailing Address - Country:US
Mailing Address - Phone:765-649-5221
Mailing Address - Fax:765-649-1537
Practice Address - Street 1:1628 MEDICAL ARTS BLVD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011-3441
Practice Address - Country:US
Practice Address - Phone:765-649-5221
Practice Address - Fax:765-649-1537
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01020462A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100048350AMedicaid
IN305110AMedicare ID - Type Unspecified
INC24102Medicare UPIN