MEDICARE: DR. BONITA L 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	207V00000X	Obstetrics & Gynecology Physician	4301084649	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00245388	OTHER	MI	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1907923	OTHER	MI	CIGNA
2	1601110521	OTHER	MI	BLUE CROSS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	01-30395	OTHER	MI	PHP

General Provider Information

NPI Number	:	1629042650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BONITA L JONES M.D

Provider Business Mailing Address
First Line	:	960 AGARD AVE
Second Line	:
City	:	BENTON HARBOR
State	:	MI
Zip	:	49022-4051
Country	:	US
Telephone Number	:	269-927-5162
Fax Number	:	269-928-5319

Provider Business Practice Location Address
First Line	:	960 AGARD AVE
Second Line	:
City	:	BENTON HARBOR
State	:	MI
Zip	:	49022-4051
Country	:	US
Telephone Number	:	269-927-5162
Fax Number	:	269-928-5319

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

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	03/07/2023

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Directions to “ DR. BONITA L JONES M.D” Practice Location

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