Provider Demographics
NPI:1255575189
Name:SYDNEY R. JONES, M.D., P.A.
Entity type:Organization
Organization Name:SYDNEY R. JONES, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SYDNEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-683-4513
Mailing Address - Street 1:185 CALEB ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2237
Mailing Address - Country:US
Mailing Address - Phone:214-683-4513
Mailing Address - Fax:
Practice Address - Street 1:185 CALEB ST
Practice Address - Street 2:LB70
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2237
Practice Address - Country:US
Practice Address - Phone:214-683-4513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-22
Last Update Date:2014-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD4894208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX098951902Medicaid
TX098951902Medicaid
TXC17562Medicare UPIN