Provider Demographics
| NPI: | 1932269024 |
|---|---|
| Name: | ROBERT JONES MD |
| Entity type: | Organization |
| Organization Name: | ROBERT JONES MD |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | OFFICE MANAGER |
| Authorized Official - Prefix: | MRS |
| Authorized Official - First Name: | VICKI |
| Authorized Official - Middle Name: | K |
| Authorized Official - Last Name: | OTT |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 304-728-5051 |
| Mailing Address - Street 1: | 207 E 5TH AVE |
| Mailing Address - Street 2: | |
| Mailing Address - City: | RANSON |
| Mailing Address - State: | WV |
| Mailing Address - Zip Code: | 25438-1613 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 304-728-5051 |
| Mailing Address - Fax: | 304-728-9735 |
| Practice Address - Street 1: | 207 E 5TH AVE |
| Practice Address - Street 2: | |
| Practice Address - City: | RANSON |
| Practice Address - State: | WV |
| Practice Address - Zip Code: | 25438-1613 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 304-728-5051 |
| Practice Address - Fax: | 304-728-9735 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-12-11 |
| Last Update Date: | 2020-08-22 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| WV | 19784 | 207RA0000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207RA0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Adolescent Medicine | Group - Single Specialty |