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General NPI Number Information
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NPI Number | 1942292412
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Entity Type | Individual
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Provider Name | DAVID ANTHONY JONES MD
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Gender | Male
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Dates
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Enumeration Date | 08/19/2005
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Last Update Date | 06/17/2015
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Provider Practice Location Address
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Address Line | 1770 E LAKE SHORE DR SUITE 305
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City | DECATUR
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State | IL
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Zip | 62521-3832
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Country | US
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Telephone | 217-424-9193
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Fax | 217-424-9195
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Provider Business Mailing Address
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Address Line | 1770 E LAKE SHORE DR SUITE 305
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City | DECATUR
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State | IL
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Zip | 62521-3836
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Country | US
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Telephone | 217-424-9193
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Fax | 217-424-9195
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036096191
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License Number State | IL
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