Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | PD 2099 | MA |
NPI | 1336249622 |
---|---|
Provider Name | Dr. Patrick Matthew Jones |
First Address | Springfield, MA 01107-1610 |
Second Address | Springfield, MA 01107-1610 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0310832 | (05) | MA |
U72002 | (02) | |
Y71046 | BLUE CROSS PROVIDER (01) | |
Y78037 | BLUE CROSS GROUP NUMBER (01) |