Healthcare Provider Details

I. General information

NPI: 1275843088
Provider Name (Legal Business Name): MICHAEL C. JONES, M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2010
Last Update Date: 10/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 S. BEGLIS PARKWAY
SULPHUR LA
70663-5906
US

IV. Provider business mailing address

1629 S. BEGLIS PARKWAY
SULPHUR LA
70663-5906
US

V. Phone/Fax

Practice location:
  • Phone: 337-527-2924
  • Fax: 337-527-2569
Mailing address:
  • Phone: 337-527-2924
  • Fax: 337-527-2569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number13368
License Number StateLA

VIII. Authorized Official

Name: MICHAEL CRAIG JONES
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 337-527-2924