Provider Demographics
NPI:1295899987
Name:JONES, DAVID R (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:JONES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:191 MEMORIAL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:54923-1241
Mailing Address - Country:US
Mailing Address - Phone:920-361-2500
Mailing Address - Fax:920-361-2973
Practice Address - Street 1:191 MEMORIAL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BERLIN
Practice Address - State:WI
Practice Address - Zip Code:54923-1241
Practice Address - Country:US
Practice Address - Phone:920-361-2500
Practice Address - Fax:920-361-2973
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2015-02-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI22113207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30505000Medicaid
WI004160128Medicare PIN
B53924Medicare UPIN