Provider Demographics
NPI:1255548020
Name:JONES, DOUGLAS
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3271 W CHARMWOOD DR
Mailing Address - Street 2:APT. A
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-1631
Mailing Address - Country:US
Mailing Address - Phone:810-966-0870
Mailing Address - Fax:
Practice Address - Street 1:3051 COMMERCE DR
Practice Address - Street 2:STE. 5
Practice Address - City:FORT GRATIOT
Practice Address - State:MI
Practice Address - Zip Code:48059-3866
Practice Address - Country:US
Practice Address - Phone:810-385-4463
Practice Address - Fax:810-385-8875
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care