Healthcare Provider Details

I. General information

NPI: 1952351751
Provider Name (Legal Business Name): JUSTIN MICHAEL JONES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 12/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6305 WATERFORD BLVD SUITE 115
OKLAHOMA CITY OK
73118-1122
US

IV. Provider business mailing address

6709 REED DR
OKLAHOMA CITY OK
73116-2130
US

V. Phone/Fax

Practice location:
  • Phone: 405-848-3459
  • Fax: 405-848-5401
Mailing address:
  • Phone: 405-848-7767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number22456
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: