Provider Demographics
NPI:1831168426
Name:JONES, STEVEN B (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:B
Last Name:JONES
Suffix:
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 1:1153 N WATERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-7964
Mailing Address - Country:US
Mailing Address - Phone:765-430-6789
Mailing Address - Fax:
Practice Address - Street 1:1153 N WATERSIDE DR
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-7964
Practice Address - Country:US
Practice Address - Phone:765-430-6789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01050561A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200925070HMedicaid
OH2966590Medicaid
IN200213110Medicaid
INP00808442OtherRXR MCR
CACC664ZMedicare PIN
IN219950E4Medicare PIN
INP00808442OtherRXR MCR
OH2966590Medicaid
IN200925070HMedicaid
CADC664YMedicare PIN
ING89404Medicare UPIN
IN815150NNMedicare PIN
IN260390AMedicare PIN