Healthcare Provider Details

I. General information

NPI: 1033170337
Provider Name (Legal Business Name): D BRYNLEY JONES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N8070 OAK RIDGE DR
BEAVER DAM WI
53916-9063
US

IV. Provider business mailing address

N8070 OAK RIDGE DR
BEAVER DAM WI
53916-9063
US

V. Phone/Fax

Practice location:
  • Phone: 920-356-6232
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number40854-020
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number40854
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: