Provider Demographics
NPI:1801044847
Name:JONES, CHRISTIANA NWOFOR (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTIANA
Middle Name:NWOFOR
Last Name:JONES
Suffix:
Gender:F
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 9101
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-9494
Mailing Address - Country:US
Mailing Address - Phone:972-745-7500
Mailing Address - Fax:972-745-4336
Practice Address - Street 1:720 S MAIN ST
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-4936
Practice Address - Country:US
Practice Address - Phone:817-431-2800
Practice Address - Fax:817-431-0371
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08387800207Q00000X
TXN0868207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX201321102Medicaid
TXP00662741OtherRAILROAD MEDICARE
TX201321101Medicaid
TXP00662741OtherRAILROAD MEDICARE
TX201321102Medicaid