MEDICARE: LARRY W JONES MD

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	MD009439E	PA

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	:	1578564498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY W JONES MD

Provider Business Mailing Address
First Line	:	PO BOX 75
Second Line	:
City	:	ROARING SPRING
State	:	PA
Zip	:	16673-0075
Country	:	US
Telephone Number	:	814-224-4439
Fax Number	:	814-224-5930

Provider Business Practice Location Address
First Line	:	99 NASON DR
Second Line	:
City	:	ROARING SPRING
State	:	PA
Zip	:	16673-1203
Country	:	US
Telephone Number	:	814-224-4439
Fax Number	:	814-224-5930

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

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	04/25/2014

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