Provider Demographics
NPI:1912953860
Name:JONES, DAVID WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:WILLIAM
Last Name:JONES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:550 GAGE BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-9532
Mailing Address - Country:US
Mailing Address - Phone:509-942-3627
Mailing Address - Fax:509-627-2983
Practice Address - Street 1:9605 SANDIFUR PARKWAY
Practice Address - Street 2:KADLEC CLINIC-PRIMARY CARE
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301
Practice Address - Country:US
Practice Address - Phone:509-942-3170
Practice Address - Fax:509-543-9795
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2021-11-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00045411207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1912953860Medicaid
WA1912953860Medicaid