Healthcare Provider Details

I. General information

NPI: 1679577241
Provider Name (Legal Business Name): DELVIN R JONES M.S., P.A.-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 W MAIN ST STE 120
BATTLE GROUND WA
98604-4311
US

IV. Provider business mailing address

PO BOX 4825
PORTLAND OR
97208-4825
US

V. Phone/Fax

Practice location:
  • Phone: 360-882-2778
  • Fax: 360-604-1690
Mailing address:
  • Phone: 360-882-2778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10002281
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA10002281
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: