Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 01039151 | IN |
NPI | 1013951292 |
---|---|
Provider Name | Marc A. Jones |
First Address | Bedford, IN 47421 |
Second Address | Bedford, IN 47421 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 02/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100167110A | (05) | IN |
E47193 | (02) | IN |