Provider Demographics
NPI: | 1932269024 |
---|---|
Name: | ROBERT JONES MD |
Entity Type: | Organization |
Organization Name: | ROBERT JONES MD |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OFFICE MANAGER |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | VICKI |
Authorized Official - Middle Name: | K |
Authorized Official - Last Name: | OTT |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 304-728-5051 |
Mailing Address - Street 1: | 207 E 5TH AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | RANSON |
Mailing Address - State: | WV |
Mailing Address - Zip Code: | 25438-1613 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 304-728-5051 |
Mailing Address - Fax: | 304-728-9735 |
Practice Address - Street 1: | 207 E 5TH AVE |
Practice Address - Street 2: | |
Practice Address - City: | RANSON |
Practice Address - State: | WV |
Practice Address - Zip Code: | 25438-1613 |
Practice Address - Country: | US |
Practice Address - Phone: | 304-728-5051 |
Practice Address - Fax: | 304-728-9735 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-12-11 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
WV | 19784 | 207RA0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207RA0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Adolescent Medicine | Group - Single Specialty |