Healthcare Provider Details

I. General information

NPI: 1538674783
Provider Name (Legal Business Name): TIMOTHY JONES MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2017
Last Update Date: 05/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13150 N MACARTHUR BLVD
OKLAHOMA CITY OK
73142-3017
US

IV. Provider business mailing address

PO BOX 270663
OKLAHOMA CITY OK
73137-0663
US

V. Phone/Fax

Practice location:
  • Phone: 405-300-8500
  • Fax: 405-554-4085
Mailing address:
  • Phone: 405-418-4800
  • Fax: 405-418-4820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number31852
License Number StateOK

VIII. Authorized Official

Name: TIMOTHY JONES
Title or Position: OWNER
Credential: MD
Phone: 314-495-5899