Provider Demographics
NPI:1649276924
Name:JONES, ROBERT R (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:R
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:PO BOX 13
Mailing Address - Street 2:
Mailing Address - City:LIBERAL
Mailing Address - State:MO
Mailing Address - Zip Code:64762-0013
Mailing Address - Country:US
Mailing Address - Phone:417-843-2008
Mailing Address - Fax:417-843-2010
Practice Address - Street 1:148 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:MO
Practice Address - Zip Code:64762-9314
Practice Address - Country:US
Practice Address - Phone:417-843-2008
Practice Address - Fax:417-843-2010
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2019-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7614207Q00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200408706Medicaid
MO200408706Medicaid
MOH753724Medicare PIN