Provider Demographics
NPI:1295793792
Name:JONES, PETER GAYLORD (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:GAYLORD
Last Name:JONES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4011 TALBOT RD S
Mailing Address - Street 2:#210
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5773
Mailing Address - Country:US
Mailing Address - Phone:425-255-4250
Mailing Address - Fax:425-271-3294
Practice Address - Street 1:4011 TALBOT RD S
Practice Address - Street 2:#210
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5773
Practice Address - Country:US
Practice Address - Phone:425-255-4250
Practice Address - Fax:425-271-3294
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00023016174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1071919Medicaid
WA1071919Medicaid
102594Medicare PIN