MEDICARE: DR. KENNETH A 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	207W00000X	Ophthalmology Physician	R3799	AR

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	:	1568510949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH A JONES M.D.

Provider Business Mailing Address
First Line	:	360 HIGHWAY 5 N
Second Line	:
City	:	MOUNTAIN HOME
State	:	AR
Zip	:	72653-3039
Country	:	US
Telephone Number	:	870-425-2277
Fax Number	:	870-425-2021

Provider Business Practice Location Address
First Line	:	360 HIGHWAY 5 N
Second Line	:
City	:	MOUNTAIN HOME
State	:	AR
Zip	:	72653-3039
Country	:	US
Telephone Number	:	870-425-2277
Fax Number	:	870-425-2021

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	11/12/2007

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