Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | TX13355 | TX |
NPI | 1134226947 |
---|---|
Provider Name | Dr. John D Jones |
First Address | San Antonio, TX 78229-3900 |
Second Address | San Antonio, TX 78229 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
09658801 | (05) | TX |
819382 | UNITED CONCORDIA (01) | |
83Y644 | BLUE CROSS BLUE SHIELD (01) | |
U44552 | (02) |