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General NPI Number Information
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NPI Number | 1912015330
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Entity Type | Individual
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Provider Name | ROBERT RANDALL JONES JR. MD
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Gender | Male
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Dates
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Enumeration Date | 08/26/2006
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Last Update Date | 06/08/2023
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Provider Practice Location Address
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Address Line | 1951 BENCH RD #C
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City | POCATELLO
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State | ID
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Zip | 83201
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Country | US
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Telephone | 208-238-3377
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Fax | 208-238-8091
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Provider Business Mailing Address
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Address Line | 1951 BENCH RD #C
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City | POCATELLO
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State | ID
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Zip | 83201
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Country | US
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Telephone | 208-238-3377
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Fax | 208-238-8091
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | M6955
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License Number State | ID
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