Provider Demographics
NPI:1265403570
Name:JONES, JOHN R (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:JONES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1421 E OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-4434
Mailing Address - Country:US
Mailing Address - Phone:954-565-0875
Mailing Address - Fax:954-565-0876
Practice Address - Street 1:1421 E OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-4434
Practice Address - Country:US
Practice Address - Phone:954-565-0875
Practice Address - Fax:954-565-0876
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2017-02-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME83421207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
19148OtherEVOLUTIONS
FL7001067OtherCIGNA
FLM834211OtherPREFERRED MEDICAL PLAN
FL293671OtherAVMED
FL78938OtherBCBS
FL267289800Medicaid
FL7468500OtherAETNA
19148OtherEVOLUTIONS
FLM834211OtherPREFERRED MEDICAL PLAN