Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | Q7397 | TX |
NPI | 1376839688 |
---|---|
Provider Name | Jeremy Ryan Jones |
First Address | Lubbock, TX 79410-1334 |
Second Address | Lubbock, TX 79410-1334 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2011 |
Last Update Date | 22/04/2019 |