Provider Demographics
NPI:1952351751
Name:JONES, JUSTIN MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:MICHAEL
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 1:6709 REED DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-2130
Mailing Address - Country:US
Mailing Address - Phone:405-848-7767
Mailing Address - Fax:
Practice Address - Street 1:6305 WATERFORD BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-1122
Practice Address - Country:US
Practice Address - Phone:405-848-3459
Practice Address - Fax:405-848-5401
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22456208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
242636301Medicare PIN