Provider Demographics
NPI:1912015330
Name:JONES, ROBERT RANDALL JR (MD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:RANDALL
Last Name:JONES
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1951 BENCH RD
Mailing Address - Street 2:#C
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201
Mailing Address - Country:US
Mailing Address - Phone:208-238-3377
Mailing Address - Fax:208-238-8091
Practice Address - Street 1:1951 BENCH RD
Practice Address - Street 2:#C
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201
Practice Address - Country:US
Practice Address - Phone:208-238-3377
Practice Address - Fax:208-238-8091
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-26
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM6955207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000223700Medicaid
180029065OtherR/R MEDICARE
ID11344491OtherMEDICARE PTAN
ID000010001691OtherB/S
ID19554OtherB/C
180029065OtherR/R MEDICARE
ID1134449Medicare ID - Type Unspecified