Provider Demographics
NPI:1013951292
Name:JONES, MARC A (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:A
Last Name:JONES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 16TH STREET
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421
Mailing Address - Country:US
Mailing Address - Phone:812-279-0148
Mailing Address - Fax:812-279-5155
Practice Address - Street 1:1901 16TH STREET
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421
Practice Address - Country:US
Practice Address - Phone:812-279-0148
Practice Address - Fax:812-279-5155
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039151207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100167110AMedicaid
IN493930Medicare PIN
IN100167110AMedicaid
IN180012822Medicare PIN
IN5987240001Medicare NSC