Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | ME0077298 | FL |
N | 207YS0123X | Facial Plastic Surgeon | 22542 | AL |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | ME77298 | FL |
NPI | 1003897778 |
---|---|
Provider Name | Dr. Derek A Jones |
First Address | Pensacola, FL 32514-6050 |
Second Address | Pensacola, FL 32514-6050 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2005 |
Last Update Date | 19/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G90329 | (02) |