Provider Demographics
NPI:1790820058
Name:JONES, MICHAEL LAWRANCE (CST CSA)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LAWRANCE
Last Name:JONES
Suffix:
Gender:M
Credentials:CST CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3961 E CHANDLER BLVD
Mailing Address - Street 2:STE 111-385
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-0303
Mailing Address - Country:US
Mailing Address - Phone:480-545-2610
Mailing Address - Fax:480-545-2673
Practice Address - Street 1:3961 E CHANDLER BLVD
Practice Address - Street 2:STE 111-385
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-0303
Practice Address - Country:US
Practice Address - Phone:480-545-2610
Practice Address - Fax:480-545-2673
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
468134246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant