Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 036069104 | IL |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 036069104 | IL |
NPI | 1417956509 |
---|---|
Provider Name | Dr. Paul John Jones |
First Address | Maywood, IL 60153-3328 |
Second Address | Chicago, IL 60612-4861 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2005 |
Last Update Date | 12/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036069104 | (05) | IL |
CB1567 | (02) |