Provider Demographics
NPI:1942292412
Name:JONES, DAVID ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ANTHONY
Last Name:JONES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1770 E LAKE SHORE DR
Mailing Address - Street 2:SUITE 305
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521-3836
Mailing Address - Country:US
Mailing Address - Phone:217-424-9193
Mailing Address - Fax:217-424-9195
Practice Address - Street 1:1770 E LAKE SHORE DR
Practice Address - Street 2:SUITE 305
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-3832
Practice Address - Country:US
Practice Address - Phone:217-424-9193
Practice Address - Fax:217-424-9195
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2015-06-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036096191207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG56801Medicare UPIN