MEDICARE: DR. C. ALVIN JONES M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	D2477	TX

General Provider Information

NPI Number	:	1316946692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. C. ALVIN JONES M.D.

Provider Business Mailing Address
First Line	:	704 OLD MONTGOMERY RD
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77301-2740
Country	:	US
Telephone Number	:	936-539-4004
Fax Number	:	936-539-3635

Provider Business Practice Location Address
First Line	:	704 OLD MONTGOMERY RD
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77301-2740
Country	:	US
Telephone Number	:	936-539-4004
Fax Number	:	936-539-3635

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	07/08/2007

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