=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982826855
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JONATHAN M JONES D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2007
-----------------------------------------------------
Last Update Date | 11/16/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 114 W. 11TH STREET HMS MED SQUARE CLINIC
-----------------------------------------------------
City | SILVER CITY
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88061-5136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-388-1511
-----------------------------------------------------
Fax | 575-542-8367
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 530 DEMOSS STREET HIDALGO MEDICAL SERVICES
-----------------------------------------------------
City | LORDSBURG
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88045-2618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-542-8384
-----------------------------------------------------
Fax | 575-542-8367
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 4615
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | A-1692-12
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------