Provider Demographics
NPI:1780784306
Name:JONES, TIMOTHY L (DO)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:L
Last Name:JONES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4046
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65808-4046
Mailing Address - Country:US
Mailing Address - Phone:417-269-5712
Mailing Address - Fax:417-269-7567
Practice Address - Street 1:1530 E REPUBLIC RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-6530
Practice Address - Country:US
Practice Address - Phone:417-269-1362
Practice Address - Fax:417-269-1372
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO115206207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
143129OtherBLUE CROSS MO
MO245226402Medicaid
G96694Medicare UPIN
008012299Medicare PIN
MO245226402Medicaid
963255132Medicare PIN
080171420Medicare PIN