Provider Demographics
NPI:1245261437
Name:JONES, TAE DANIEL (CRNA)
Entity type:Individual
Prefix:
First Name:TAE
Middle Name:DANIEL
Last Name:JONES
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 650426
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0426
Mailing Address - Country:US
Mailing Address - Phone:972-715-5000
Mailing Address - Fax:
Practice Address - Street 1:13737 NOEL RD
Practice Address - Street 2:STE 1400
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-2004
Practice Address - Country:US
Practice Address - Phone:972-715-5000
Practice Address - Fax:972-715-9976
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX644451367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89625UOtherBCBS
OK200010660AMedicaid
TX157890804Medicaid
TX157890805Medicaid
TX83825UOtherBLUE CROSS BLUE SHIELD
TX157890802Medicaid
TXP00119641OtherRAILROAD MEDICARE
TXP00957424OtherRAILROAD
TX157890805Medicaid
TX8B4784Medicare PIN
TX83825UOtherBLUE CROSS BLUE SHIELD
TXP85419Medicare UPIN
TXTXB107401Medicare PIN