Provider Demographics
NPI:1881675965
Name:JONES, DAPHNE L (MD)
Entity Type:Individual
Prefix:
First Name:DAPHNE
Middle Name:L
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 1:523 GANDY ST NE STE F
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35653-1961
Mailing Address - Country:US
Mailing Address - Phone:256-331-3988
Mailing Address - Fax:256-331-3987
Practice Address - Street 1:523 GANDY ST NE STE F
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AL
Practice Address - Zip Code:35653-1961
Practice Address - Country:US
Practice Address - Phone:256-331-3988
Practice Address - Fax:256-331-3987
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9900075207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G89693Medicare UPIN