Provider Demographics
NPI:1245315787
Name:JONES, ROBERT W (PA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:JONES
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2351 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-3972
Mailing Address - Country:US
Mailing Address - Phone:309-691-1400
Mailing Address - Fax:
Practice Address - Street 1:2351 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-3972
Practice Address - Country:US
Practice Address - Phone:309-691-1400
Practice Address - Fax:309-620-9159
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085002847363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical