Healthcare Provider Details

I. General information

NPI: 1225560964
Provider Name (Legal Business Name): NATHAN MERRITT JONES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2017
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

673 MDG / JB ELMENDORF-RICHARDSON USAF 5955 ZEAMER AVE
ANCHORAGE AK
99577
US

IV. Provider business mailing address

673 MDG / JB ELMENDORF-RICHARDSON USAF 5955 ZEAMER AVE
ANCHORAGE AK
99506
US

V. Phone/Fax

Practice location:
  • Phone: 907-551-2992
  • Fax:
Mailing address:
  • Phone: 907-551-2992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number11483499-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number11483499-1205
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: