Provider Demographics
NPI:1669050159
Name:JONES, JEFFREY WARREN (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:WARREN
Last Name:JONES
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 IVA LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-4912
Mailing Address - Country:US
Mailing Address - Phone:512-657-2683
Mailing Address - Fax:
Practice Address - Street 1:2202 IVA LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-4912
Practice Address - Country:US
Practice Address - Phone:512-657-2683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-29
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA14418363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA14418OtherTEXAS MEDICAL BOARD