Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | D1690 | TX |
NPI | 1134128119 |
---|---|
Provider Name | Gene E. Jones |
First Address | Port Arthur, TX 77640-2002 |
Second Address | Port Arthur, TX 77640-2002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2005 |
Last Update Date | 05/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00194Z | MEDICARE PTAN (01) | TX |
128460603 | (05) | TX |
C17609 | (02) | TX |