Provider Demographics
NPI:1982826855
Name:JONES, JONATHAN M (DO)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:M
Last Name:JONES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:530 DEMOSS STREET
Mailing Address - Street 2:HIDALGO MEDICAL SERVICES
Mailing Address - City:LORDSBURG
Mailing Address - State:NM
Mailing Address - Zip Code:88045-2618
Mailing Address - Country:US
Mailing Address - Phone:575-542-8384
Mailing Address - Fax:575-542-8367
Practice Address - Street 1:114 W. 11TH STREET
Practice Address - Street 2:HMS MED SQUARE CLINIC
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-5136
Practice Address - Country:US
Practice Address - Phone:575-388-1511
Practice Address - Fax:575-542-8367
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ4615208000000X
NMA-1692-12208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNMA1029998OtherMEDICARE PTAN
NM53286758Medicaid