Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 00319 | KY |
N | 222Z00000X | Podiatrist | 00319 | KY |
Y | 213ES0103X | Foot & Ankle Surgery | 2009018603 | MO |
NPI | 1053570903 |
---|---|
Provider Name | Brad W Jones |
First Address | Springfield, MO 65803-4306 |
Second Address | Springfield, MO 65803-4306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2008 |
Last Update Date | 23/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1053570903 | (05) | MO |
P00767556 | RR MEDICARE (01) |