Healthcare Provider Details

I. General information

NPI: 1801005053
Provider Name (Legal Business Name): MICHAEL BOZELLY JONES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3405 SAINT CLAUDE AVE
NEW ORLEANS LA
70117-6144
US

IV. Provider business mailing address

2433 BEDFORD DR
NEW ORLEANS LA
70131-4703
US

V. Phone/Fax

Practice location:
  • Phone: 504-662-3763
  • Fax: 504-875-4768
Mailing address:
  • Phone: 504-258-1766
  • Fax: 504-875-4768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number13825R
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number13825R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: