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NPI Code Detail

MEDICARE: BRUCE JONES D.O.

MEDICARE: BRUCE JONES D.O.
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
1208600000XSurgery PhysicianIL

General Provider Information

NPI Number : 1366446734
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRUCE JONES D.O.
Provider Business Mailing Address
First Line : 40 N KINGS HWY
Second Line : APT 15J
City : SAINT LOUIS
State : MO
Zip : 63108-1333
Country : US
Telephone Number : 314-361-2822
Fax Number :
Provider Business Practice Location Address
First Line : 129 N 8TH ST
Second Line :
City : EAST ST LOUIS
State : IL
Zip : 62201-2917
Country : US
Telephone Number : 618-482-7242
Fax Number : 314-810-1399
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2005
Last Update Date : 07/08/2007

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Directions to “ BRUCE JONES D.O.” Practice Location

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