Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 9786 | ND |
NPI | 1013004969 |
---|---|
Provider Name | Frederick W Jones |
First Address | Minot, ND 58702-5010 |
Second Address | Minot, ND 58701-4768 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 25/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
13128 | (05) | ND |
H26128 | (02) |