Provider Demographics
NPI:1487688867
Name:JONES, HUBERT R (PA-C)
Entity type:Individual
Prefix:MR
First Name:HUBERT
Middle Name:R
Last Name:JONES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 N FRONT ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17102-2414
Mailing Address - Country:US
Mailing Address - Phone:717-236-4682
Mailing Address - Fax:717-236-2423
Practice Address - Street 1:1617 N FRONT ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17102-2414
Practice Address - Country:US
Practice Address - Phone:717-236-4682
Practice Address - Fax:717-236-2423
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA000015L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011811520001Medicaid
PAMA000015LOtherSTATE MEDICAL LICENSE
PAMA000015LOtherSTATE MEDICAL LICENSE
PAR06761Medicare UPIN
PAMJ0192409OtherDEA