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General NPI Number Information
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NPI Number | 1255534798
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Entity Type | Organization
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Legal Business Name | PETER D JONES MD PC
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 14 QUARRY ST
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City | WILLIMANTIC
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State | CT
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Zip | 06226-1232
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Country | US
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Telephone | 860-423-8020
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Fax | 860-456-8288
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Provider Business Mailing Address
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Address Line | 14 QUARRY ST
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City | WILLIMANTIC
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State | CT
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Zip | 06226-1232
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Country | US
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Telephone | 860-423-8020
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Fax | 860-456-8288
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Authorized Official
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Title or Position | PRESIDENT
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Name | PETER D JONES
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Credential | MD
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Telephone | 860-423-8020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 001754
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License Number State | CT
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