MEDICARE: DR. KEVIN C 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	2085N0700X	Neuroradiology Physician	53764	GA
2	2085N0700X	Neuroradiology Physician	205663-1	NY
3	2085N0700X	Neuroradiology Physician	MMD.28538 MD	SC
4	2085N0700X	Neuroradiology Physician	ME 88907	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336194414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN C JONES M.D.

Provider Business Mailing Address
First Line	:	129 CARRIAGE LAMP WAY
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-1903
Country	:	US
Telephone Number	:	904-728-8825
Fax Number	:

Provider Business Practice Location Address
First Line	:	129 CARRIAGE LAMP WAY
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-1903
Country	:	US
Telephone Number	:	904-728-8825
Fax Number	:

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

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	08/21/2013

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