Healthcare Provider Details

I. General information

NPI: 1659356434
Provider Name (Legal Business Name): LARRY M. JONES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 11/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 W 10TH AVE
COLUMBUS OH
43210-1240
US

IV. Provider business mailing address

700 ACKERMAN RD SUITE 570
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-2101
  • Fax: 614-293-9155
Mailing address:
  • Phone: 614-293-5710
  • Fax: 614-293-9155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35042853
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberMD037893E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: