Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | F4131 | TX |
NPI | 1073557930 |
---|---|
Provider Name | Dr. Michael C Jones |
First Address | Fredericksburg, TX 78624-4444 |
Second Address | Fredericksburg, TX 78624-4444 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 30/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00FP77 | BCBS PROVIDER # (01) | TX |
0616600001 | MEDICARE PALMETTO DME # (01) | TX |
126479804 | (05) | TX |
340001356 | MEDICARE RAILROAD # (01) | TX |
D66672 | (02) | TX |