MEDICARE: DR. TIMOTHY HOLLISTER JONES MD

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	A55265	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1497116701	OTHER	CA	NPI TIMOTHYJONES MD INC
2	A55265	OTHER	CA	STATE LICENSE
3	CB254654	OTHER		PTAN

General Provider Information

NPI Number	:	1366437402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY HOLLISTER JONES MD

Provider Business Mailing Address
First Line	:	PO BOX 159
Second Line	:
City	:	AVILA BEACH
State	:	CA
Zip	:	93424-0159
Country	:	US
Telephone Number	:	805-556-7006
Fax Number	:	805-439-1482

Provider Business Practice Location Address
First Line	:	6621 BAY LAUREL PL STE A
Second Line	:
City	:	AVILA BEACH
State	:	CA
Zip	:	93424-3504
Country	:	US
Telephone Number	:	805-556-7006
Fax Number	:	805-439-1482

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

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	12/30/2022

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