Provider Demographics
NPI:1013949684
Name:JONES, WALTER D (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:D
Last Name:JONES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1286
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47151-1286
Mailing Address - Country:US
Mailing Address - Phone:502-456-6212
Mailing Address - Fax:502-456-4440
Practice Address - Street 1:1850 STATE ST
Practice Address - Street 2:PATHOLOGY DEPT
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4990
Practice Address - Country:US
Practice Address - Phone:812-948-7408
Practice Address - Fax:812-949-5810
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01026772207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100151810AMedicaid
KY64167935OtherKENTUCKY MEDICAID
INP01286270OtherMEDICARE RR
KY000000854782OtherANTHEM
KY50063199OtherPASSPORT
IN100151810AMedicaid
INP01286270OtherMEDICARE RR
KY000000854782OtherANTHEM
IN242390DMedicare PIN
280028OtherBLACK LUNG PROGRAM
220006934OtherRAILROAD MEDICARE
INC65191Medicare UPIN