Healthcare Provider Details

I. General information

NPI: 1558434795
Provider Name (Legal Business Name): DAVID ROY JONES PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 W JACKSON ST STE 206
CARBONDALE IL
62901-1474
US

IV. Provider business mailing address

PO BOX 3988 1239 E MAIN STREET
CARBONDALE IL
62901
US

V. Phone/Fax

Practice location:
  • Phone: 618-457-3006
  • Fax: 618-457-3007
Mailing address:
  • Phone: 618-457-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2023019428
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085-001642
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number085-001642
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: