Provider Demographics
NPI:1740273085
Name:JONES, SHIRLEY EILEEN (MD)
Entity type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:EILEEN
Last Name:JONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6856 103RD ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-6877
Mailing Address - Country:US
Mailing Address - Phone:904-777-0616
Mailing Address - Fax:904-111-0688
Practice Address - Street 1:6856 103RD ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-6877
Practice Address - Country:US
Practice Address - Phone:904-777-0616
Practice Address - Fax:904-111-0688
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049042207Q00000X
AL22666207Q00000X
FLME113465207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000882846CMedicaid
FL14KY6OtherBCBS
FL005941800Medicaid
FL14KY6OtherBCBS