Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 036128527 | IL |
N | 207Q00000X | Family Doctor | 276596-1 | NY |
N | 207Q00000X | Family Doctor | MD22085 | ME |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 276596-1 | NY |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | ME139014 | FL |
NPI | 1194037770 |
---|---|
Provider Name | Anthony Jones |
First Address | Albany, NY 12211-0142 |
Second Address | Hudson, NY 12534-2907 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2010 |
Last Update Date | 21/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036128527 | (05) | IL |
FJ6150560 | DEA (01) | |
ME139014 | MD LICENSE (01) | FL |