Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 12006467A | IN |
Y | 213EG0000X | General Practice | 12006467A | IN |
NPI | 1003915026 |
---|---|
Provider Name | Dr. Phillip L. Jones |
First Address | Roanoke, IN 46783-9155 |
Second Address | Roanoke, IN 46783-0039 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 08/07/2007 |