Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | D1689 | TX |
NPI | 1215905088 |
---|---|
Provider Name | Dr. Edgar F Jones III |
First Address | Galveston, TX 77551-5829 |
Second Address | Galveston, TX 77550-8940 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2006 |
Last Update Date | 05/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0084MM | BCBS (01) | TX |
136921710 | (05) | TX |
C17573 | (02) | TX |