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General NPI Number Information
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NPI Number | 1316334881
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Entity Type | Individual
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Provider Name | RYAN DALE JONES M.D., PH.D.
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Gender | Male
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Dates
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Enumeration Date | 04/22/2015
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Last Update Date | 01/04/2022
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Provider Practice Location Address
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Address Line | 600 W CHICAGO AVE STE 510
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City | CHICAGO
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State | IL
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Zip | 60654-2282
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Country | US
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Telephone | 630-247-8514
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Fax |
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Provider Business Mailing Address
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Address Line | 1633 IMPERIAL CIR
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City | NAPERVILLE
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State | IL
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Zip | 60563-0132
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Country | US
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Telephone | 630-247-8514
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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 | 207ZP0101X
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Taxonomy Name | Anatomic Pathology Physician
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License Number | 036.144898
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License Number State | IL
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