Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 2140 | NC |
N | 204C00000X | Sports Medicine Doctor | 831 | OK |
Y | 204C00000X | Sports Medicine Doctor | AT005080 | OH |
NPI | 1316354137 |
---|---|
Provider Name | Mr. Sean Jones |
First Address | Columbus, OH 43210-1044 |
Second Address | Columbus, OH 43210-1044 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2014 |
Last Update Date | 15/07/2017 |