MEDICARE: GORDON WENDELL JONES CRT

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	247100000X	Radiologic Technologist	RHF18701	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437215464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GORDON WENDELL JONES CRT

Provider Business Mailing Address
First Line	:	PO BOX 492615
Second Line	:
City	:	REDDING
State	:	CA
Zip	:	96049-2615
Country	:	US
Telephone Number	:	530-221-8731
Fax Number	:	530-221-8731

Provider Business Practice Location Address
First Line	:	2468 BIRCHWOOD CIR
Second Line	:
City	:	REDDING
State	:	CA
Zip	:	96002-3748
Country	:	US
Telephone Number	:	530-221-8731
Fax Number	:	530-221-8731

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

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	01/04/2008

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