Provider Demographics
NPI:1841355906
Name:JONES, ROBERT BUCKNER JR (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BUCKNER
Last Name:JONES
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 652
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-0652
Mailing Address - Country:US
Mailing Address - Phone:218-330-5310
Mailing Address - Fax:
Practice Address - Street 1:4300 LOWER ROY LAKE RD
Practice Address - Street 2:
Practice Address - City:NISSWA
Practice Address - State:MN
Practice Address - Zip Code:56468-2726
Practice Address - Country:US
Practice Address - Phone:218-330-5310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN287312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MND80058Medicare UPIN