Provider Demographics
NPI:1457370397
Name:JONES, JOHN STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:STEPHEN
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 1:38107 POTATO CYN RD
Mailing Address - Street 2:
Mailing Address - City:OAK GLEN
Mailing Address - State:CA
Mailing Address - Zip Code:92399
Mailing Address - Country:US
Mailing Address - Phone:909-790-5176
Mailing Address - Fax:
Practice Address - Street 1:38107 POTATO CANYON RD
Practice Address - Street 2:
Practice Address - City:OAK GLEN
Practice Address - State:CA
Practice Address - Zip Code:92399-9489
Practice Address - Country:US
Practice Address - Phone:909-790-5176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29992207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A299920Medicaid
A25937Medicare UPIN
00A299920Medicare ID - Type Unspecified