Provider Demographics
NPI:1750369658
Name:JONES, GEORGE THOMAS III (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:THOMAS
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 1:2112 W JEFFERSON ST
Mailing Address - Street 2:SUITE 222
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-6663
Mailing Address - Country:US
Mailing Address - Phone:815-725-4566
Mailing Address - Fax:815-725-5351
Practice Address - Street 1:2112 W JEFFERSON ST
Practice Address - Street 2:SUITE 222
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6663
Practice Address - Country:US
Practice Address - Phone:815-725-4566
Practice Address - Fax:815-725-5351
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL239770Medicare ID - Type Unspecified
ILA36290Medicare UPIN