Healthcare Provider Details

I. General information

NPI: 1063945517
Provider Name (Legal Business Name): DONALD R JONES ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 04/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 PHYSICIANS PARK STE 300
POPLAR BLUFF MO
63901-3930
US

IV. Provider business mailing address

RR 1 BOX 182
WILLIAMSVILLE MO
63967-9722
US

V. Phone/Fax

Practice location:
  • Phone: 573-785-0313
  • Fax: 573-727-0079
Mailing address:
  • Phone: 573-429-7677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2000146677
License Number StateMO

VIII. Authorized Official

Name: DR. DONALD R JONES III
Title or Position: OWNER
Credential: MD
Phone: 573-429-7677