Healthcare Provider Details

I. General information

NPI: 1255331021
Provider Name (Legal Business Name): ROBERT E JONES III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date: 03/21/2006
Reactivation Date: 04/06/2006

III. Provider practice location address

207 E 5TH AVE
RANSON WV
25438-1613
US

IV. Provider business mailing address

207 E 5TH AVE
RANSON WV
25438-1613
US

V. Phone/Fax

Practice location:
  • Phone: 304-728-5051
  • Fax: 304-728-9735
Mailing address:
  • Phone: 304-728-5051
  • Fax: 304-728-9735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number19784
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number19784
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: