Healthcare Provider Details

I. General information

NPI: 1982826855
Provider Name (Legal Business Name): JONATHAN M JONES D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 11/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 W. 11TH STREET HMS MED SQUARE CLINIC
SILVER CITY NM
88061-5136
US

IV. Provider business mailing address

530 DEMOSS STREET HIDALGO MEDICAL SERVICES
LORDSBURG NM
88045-2618
US

V. Phone/Fax

Practice location:
  • Phone: 575-388-1511
  • Fax: 575-542-8367
Mailing address:
  • Phone: 575-542-8384
  • Fax: 575-542-8367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4615
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA-1692-12
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: