MEDICARE: RICHARD EDWARD 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	207XS0106X	Orthopaedic Hand Surgery Physician	D4790	TX
2	207X00000X	Orthopaedic Surgery Physician	D4790	TX
3	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician	D4790	TX
4	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	D4790	TX
5	207XX0801X	Orthopaedic Trauma Physician	D4790	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	89035F	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558367664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD EDWARD JONES M.D.

Provider Business Mailing Address
First Line	:	PO BOX 660046
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75266-0046
Country	:	US
Telephone Number	:	214-369-8555
Fax Number	:	214-369-2683

Provider Business Practice Location Address
First Line	:	5920 FOREST PARK RD
Second Line	:	STE 600
City	:	DALLAS
State	:	TX
Zip	:	75235-6416
Country	:	US
Telephone Number	:	214-902-1556
Fax Number	:

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

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	05/07/2008

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