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General NPI Number Information
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NPI Number | 1972696565
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Entity Type | Individual
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Provider Name | MICHAEL GARY JONES D.O.
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Gender | Male
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 07/19/2012
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Provider Practice Location Address
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Address Line | 777 HOSPITAL WAY BLDG A SUITE 300
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City | POCATELLO
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State | ID
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Zip | 83201-5176
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Country | US
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Telephone | 208-232-6100
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Fax |
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Provider Business Mailing Address
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Address Line | 777 HOSPITAL WAY BLDG A SUITE 300
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City | POCATELLO
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State | ID
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Zip | 83201-5176
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Country | US
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Telephone | 208-232-6100
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | O0428
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License Number State | ID
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