Provider Demographics
NPI:1811965486
Name:JONES, CLARK ERNEST (DO)
Entity type:Individual
Prefix:DR
First Name:CLARK
Middle Name:ERNEST
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 1:2700 ROBERT T LONGWAY BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-2190
Mailing Address - Country:US
Mailing Address - Phone:810-235-2004
Mailing Address - Fax:810-235-2841
Practice Address - Street 1:1125 S LINDEN RD
Practice Address - Street 2:STE 900
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-4073
Practice Address - Country:US
Practice Address - Phone:810-733-5390
Practice Address - Fax:810-733-6090
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014011207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00258717OtherRAILROAD
MI700G210140OtherBCBS
MI700G210140OtherBCBS
MIBJ7443029OtherDEA
MIOP19260012Medicare PIN