Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 13368 | LA |
NPI | 1760464440 |
---|---|
Provider Name | Dr. Michael Craig Jones |
First Address | Lake Charles, LA 70605-5285 |
Second Address | Sulphur, LA 70663 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1564648 | (05) | LA |
D09527 | (02) | LA |