Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 4301054134 | MI |
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 4301054134 | MI |
NPI | 1245270792 |
---|---|
Provider Name | Theodore Benjamin Jones |
First Address | Troy, MI 48083-1138 |
Second Address | Wayne, MI 48184-2405 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 21/10/2020 |