Provider Demographics
NPI:1912981150
Name:JONES, CHARLES RANDALL (MD)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:RANDALL
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:UK DIVISION OF HOSPITAL MEDICINE
Mailing Address - Street 2:800 ROSE STREET, MN604
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0294
Mailing Address - Country:US
Mailing Address - Phone:859-323-6047
Mailing Address - Fax:859-257-3873
Practice Address - Street 1:UK DIVISION OF HOSPITAL MEDICINE
Practice Address - Street 2:800 ROSE STREET, MN604
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0294
Practice Address - Country:US
Practice Address - Phone:859-323-6047
Practice Address - Fax:859-257-3873
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38158207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000341398OtherANTHEM
KY64090004Medicaid
KY64090004Medicaid