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General NPI Number Information
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NPI Number | 1053428771
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Entity Type | Individual
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Provider Name | THERESA ELLEN JONES M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 01/24/2014
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Provider Practice Location Address
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Address Line | 12255 DE PAUL DR STE 360
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City | BRIDGETON
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State | MO
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Zip | 63044-2513
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Country | US
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Telephone | 314-739-9293
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Fax | 314-739-3968
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Provider Business Mailing Address
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Address Line | 12255 DE PAUL DR STE 360
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City | BRIDGETON
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State | MO
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Zip | 63044-2513
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Country | US
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Telephone | 314-739-9293
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Fax | 314-739-3968
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 2004001643
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License Number State | MO
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