Healthcare Provider Details

I. General information

NPI: 1639157134
Provider Name (Legal Business Name): CRAIG TAYLOR JONES PHYSICIAN ASST.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CAMP PENDLETON NAVAL HOSPITAL BLDG H100 ATTN: CODE 094 ,
CAMP PENDLETON CA
92055-5191
US

IV. Provider business mailing address

PO BOX 555191 ATTN: CODE 094
CAMP PENDLETON CA
92055-5191
US

V. Phone/Fax

Practice location:
  • Phone: 928-269-6091
  • Fax: 928-269-3184
Mailing address:
  • Phone: 928-269-6091
  • Fax: 928-269-3184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1041830
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: