Provider Demographics
NPI:1790807022
Name:JONES, DAVID ROBERT (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ROBERT
Last Name:JONES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1 KIM AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:TUNKHANNOCK
Mailing Address - State:PA
Mailing Address - Zip Code:18657-9101
Mailing Address - Country:US
Mailing Address - Phone:570-240-4774
Mailing Address - Fax:570-836-6888
Practice Address - Street 1:1 KIM AVE STE 1
Practice Address - Street 2:
Practice Address - City:TUNKHANNOCK
Practice Address - State:PA
Practice Address - Zip Code:18657-9101
Practice Address - Country:US
Practice Address - Phone:570-240-4774
Practice Address - Fax:570-836-6888
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA051544363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant