Provider Demographics
NPI:1790757748
Name:JONES, EDWARD BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:BRUCE
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:PO BOX 271
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD COLLEGE
Mailing Address - State:NC
Mailing Address - Zip Code:28671-0271
Mailing Address - Country:US
Mailing Address - Phone:828-438-1930
Mailing Address - Fax:828-438-1937
Practice Address - Street 1:1190 DREXEL RD
Practice Address - Street 2:
Practice Address - City:VALDESE
Practice Address - State:NC
Practice Address - Zip Code:28690-9570
Practice Address - Country:US
Practice Address - Phone:828-438-1930
Practice Address - Fax:828-438-1937
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9300167207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7947051Medicaid
NCE78859Medicare UPIN
NC2191467Medicare ID - Type UnspecifiedMEDICARE PROVIDER #