MEDICARE: JOHN JONES

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	174400000X	Specialist	86-069	NM

General Provider Information

NPI Number	:	1194726364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN JONES

Provider Business Mailing Address
First Line	:	933 BRADBURY DR SE
Second Line	:	SUITE 2222
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-4374
Country	:	US
Telephone Number	:	505-272-3120
Fax Number	:

Provider Business Practice Location Address
First Line	:	7801 ACADEMY RD NE
Second Line	:	SUITE 4
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-3379
Country	:	US
Telephone Number	:	505-272-2700
Fax Number	:	505-272-6308

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	03/22/2017

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Directions to “ JOHN JONES ” Practice Location

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