Provider Demographics
NPI:1790797504
Name:JONES, ROGER ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:ALLEN
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 1:770 S. 12TH ST
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-4054
Mailing Address - Country:US
Mailing Address - Phone:775-738-1770
Mailing Address - Fax:775-738-5341
Practice Address - Street 1:770 S. 12TH ST
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-4054
Practice Address - Country:US
Practice Address - Phone:775-738-1770
Practice Address - Fax:775-738-5341
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5164207X00000X
MN26261207X00000X
ND11238207X00000X
WAMD60095213207X00000X
TXN7439207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002004005Medicaid
NVC96199Medicare UPIN