Provider Demographics
NPI:1801005053
Name:JONES, MICHAEL BOZELLY (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BOZELLY
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 1:2433 BEDFORD DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-4703
Mailing Address - Country:US
Mailing Address - Phone:504-258-1766
Mailing Address - Fax:504-875-4768
Practice Address - Street 1:3405 SAINT CLAUDE AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70117-6144
Practice Address - Country:US
Practice Address - Phone:504-662-3763
Practice Address - Fax:504-875-4768
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13825R207RC0000X, 207UN0901X
GA044638207UN0901X, 207UN0902X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
No207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1434698Medicaid
LA1434698Medicaid
LAH23280Medicare UPIN