Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 6685 | NC |
NPI | 1861473019 |
---|---|
Provider Name | Dr. Gary T Jones |
First Address | Fayetteville, NC 28304-4450 |
Second Address | Fayetteville, NC 28304-4450 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2005 |
Last Update Date | 31/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
899006J | (05) | NC |
U70197 | (02) | NC |