Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 17025 | MS |
N | 208D00000X | General Practice Physician | 17025 | MS |
NPI | 1013001189 |
---|---|
Provider Name | Dr. Matthew Brian Jones |
First Address | Laurel, MS 39440-1980 |
Second Address | Laurel, MS 39440-1980 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 12/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00126035 | (05) | MS |
H70113 | (02) | MS |