Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC010170 | PA |
NPI | 1225360696 |
---|---|
Provider Name | Dr. Isaac Hamilton Jones |
First Address | Vancouver, WA 98685-0514 |
Second Address | Vancouver, WA 98685-0514 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2010 |
Last Update Date | 09/02/2010 |