Provider Demographics
NPI:1720213598
Name:JONES, JACOB (DPM)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 E THOMAS RD
Mailing Address - Street 2:SUITE # 420
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7848
Mailing Address - Country:US
Mailing Address - Phone:602-955-5700
Mailing Address - Fax:602-955-5701
Practice Address - Street 1:13660 N 94TH DR STE C4
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4841
Practice Address - Country:US
Practice Address - Phone:602-884-8013
Practice Address - Fax:623-259-9975
Is Sole Proprietor?:No
Enumeration Date:2009-05-22
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0736213ES0103X, 213E00000X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery