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General NPI Number Information
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NPI Number | 1669437638
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Entity Type | Individual
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Provider Name | JERRY JONES III MD
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Gender | Male
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Dates
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Enumeration Date | 04/20/2006
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Last Update Date | 10/28/2014
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Provider Practice Location Address
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Address Line | 137 N OAK PARK AVE SUITE 129
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City | OAK PARK
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State | IL
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Zip | 60301-1344
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Country | US
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Telephone | 708-434-5778
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Fax | 708-434-5032
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Provider Business Mailing Address
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Address Line | 270 E HIGHLAND AVE SUITE 424
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City | MILWAUKEE
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State | WI
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Zip | 53202-6635
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Country | US
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Telephone | 414-807-5050
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Fax | 708-434-5032
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 30065
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License Number State | WI
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