Provider Demographics
NPI:1952390569
Name:JONES, DAVID A (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
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 1:100 E LIBERTY ST, STE 800
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1428
Mailing Address - Country:US
Mailing Address - Phone:502-633-3525
Mailing Address - Fax:502-633-4067
Practice Address - Street 1:150 FAIRVIEW CT
Practice Address - Street 2:
Practice Address - City:EMINENCE
Practice Address - State:KY
Practice Address - Zip Code:40019-1158
Practice Address - Country:US
Practice Address - Phone:502-845-5672
Practice Address - Fax:502-845-5076
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25578207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0100491OtherUHC
000000048275OtherANTHEM
KY64255789Medicaid
0100491OtherUHC
0092608Medicare ID - Type Unspecified
KYP00848912Medicare PIN
KY64255789Medicaid