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General NPI Number Information
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NPI Number | 1255835724
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Entity Type | Individual
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Provider Name | WALLACE E JONES
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Gender | Male
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Dates
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Enumeration Date | 03/20/2018
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Last Update Date | 07/02/2024
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Provider Practice Location Address
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Address Line | 2635 N 7TH ST
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City | GRAND JUNCTION
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State | CO
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Zip | 81501-8209
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Country | US
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Telephone | 970-298-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 2635 N 7TH ST
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City | GRAND JUNCTION
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State | CO
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Zip | 81501-8209
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Country | US
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Telephone |
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Fax |
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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 | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | DR.0072832
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License Number State | CO
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