Provider Demographics
NPI:1922002872
Name:JONES, JASON JONATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:JONATHAN
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 1:4405 HAMILTON BLVD
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-1140
Mailing Address - Country:US
Mailing Address - Phone:712-239-3937
Mailing Address - Fax:712-239-4946
Practice Address - Street 1:4405 HAMILTON BLVD
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-1140
Practice Address - Country:US
Practice Address - Phone:712-239-3937
Practice Address - Fax:712-239-4946
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA35210207W00000X
SD5250207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN400005600Medicaid
IA1299354Medicaid
SD6300652Medicaid
IA0299354Medicaid
NE10024952400Medicaid
SD6300650Medicaid
SD6300653Medicaid
NE10025032100Medicaid
NE46044447400Medicaid
SD6300654Medicaid
IAH93207Medicare UPIN
IA1299354Medicaid
NE46044447400Medicaid
SD6300650Medicaid
IAIB1010001Medicare PIN