Provider Demographics
NPI:1922116433
Name:JONES, EDWARD J (MD PA)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:J
Last Name:JONES
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 VIRGINIA DR
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7335
Mailing Address - Country:US
Mailing Address - Phone:870-793-4300
Mailing Address - Fax:870-793-1963
Practice Address - Street 1:255 VIRGINIA DR
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7335
Practice Address - Country:US
Practice Address - Phone:870-793-4300
Practice Address - Fax:870-793-1963
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC5572174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR102763001Medicaid
ARD84196Medicare UPIN