Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | J4239 | TX |
Y | 213ES0000X | Sports Medicine | J4239 | TX |
NPI | 1396726816 |
---|---|
Provider Name | Dr. David Ray Jones |
First Address | Orange, TX 77630-4786 |
Second Address | Orange, TX 77630-4786 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2005 |
Last Update Date | 13/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
030941101 | (05) | TX |
G54909 | (02) | TX |