Provider Demographics
NPI:1962488536
Name:JONES, JUSTIN E (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:E
Last Name:JONES
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Gender:M
Credentials:MD
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Mailing Address - Street 1:670 MASON RIDGE CENTER DR
Mailing Address - Street 2:STE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8573
Mailing Address - Country:US
Mailing Address - Phone:573-815-8130
Mailing Address - Fax:573-815-8149
Practice Address - Street 1:1605 E BROADWAY
Practice Address - Street 2:SUITE 110
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8023
Practice Address - Country:US
Practice Address - Phone:573-815-8130
Practice Address - Fax:573-815-8149
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2014-10-07
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Provider Licenses
StateLicense IDTaxonomies
MO101372207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203414719Medicaid
MO203414719Medicaid
F27947Medicare UPIN