Provider Demographics
NPI:1669437638
Name:JONES, JERRY III (MD)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:
Last Name:JONES
Suffix:III
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 1:270 E HIGHLAND AVE
Mailing Address - Street 2:SUITE 424
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-6635
Mailing Address - Country:US
Mailing Address - Phone:414-807-5050
Mailing Address - Fax:708-434-5032
Practice Address - Street 1:137 N OAK PARK AVE
Practice Address - Street 2:SUITE 129
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1344
Practice Address - Country:US
Practice Address - Phone:708-434-5778
Practice Address - Fax:708-434-5032
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI30065207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31514300Medicaid
G38575Medicare UPIN
WI31514300Medicaid
WI029050150Medicare PIN
WI006800240Medicare ID - Type Unspecified