MEDICARE: CHRISTOPHER RUSSELL JONES M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	036-107237	IL
2	208000000X	Pediatrics Physician	MD60138619	WA

General Provider Information

NPI Number	:	1033156815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER RUSSELL JONES M.D.

Provider Business Mailing Address
First Line	:	409 S J ST
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98405-4226
Country	:	US
Telephone Number	:	253-403-4538
Fax Number	:

Provider Business Practice Location Address
First Line	:	409 S J ST
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98405-4226
Country	:	US
Telephone Number	:	253-403-4538
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	03/30/2011

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