Healthcare Provider Details

I. General information

NPI: 1992021505
Provider Name (Legal Business Name): KEVIN LUCAS JONES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2010
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 SW INDUSTRIAL WAY STE 201
BEND OR
97702-1066
US

IV. Provider business mailing address

803 SW INDUSTRIAL WAY STE 201
BEND OR
97702-1066
US

V. Phone/Fax

Practice location:
  • Phone: 541-422-3569
  • Fax:
Mailing address:
  • Phone: 541-422-3569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License NumberMD155789
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD155789
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: