=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346341021
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICHARD THOMAS JONES MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2006
-----------------------------------------------------
Last Update Date | 02/17/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 32 W 1ST S
-----------------------------------------------------
City | REXBURG
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83440-1810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-356-7585
-----------------------------------------------------
Fax | 208-356-7566
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 32 W 1ST S
-----------------------------------------------------
City | REXBURG
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83440-1810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-356-7585
-----------------------------------------------------
Fax | 208-356-7566
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 7553A
-----------------------------------------------------
License Number State | WY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | M-10078
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------