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NPI Code Detail

MEDICARE: DR. RICKY L JONES MD

MEDICARE: DR. RICKY L 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
1207Q00000XFamily Medicine Physician15056LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22737000007OTHERCIGNA
35979585OTHERAETNA
4080039491OTHERLARR MCR

General Provider Information

NPI Number : 1598760076
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RICKY L JONES MD
Provider Business Mailing Address
First Line : 8383 MILLICENT WAY
Second Line :
City : SHREVEPORT
State : LA
Zip : 71115-5207
Country : US
Telephone Number : 318-797-6661
Fax Number : 318-795-8512
Provider Business Practice Location Address
First Line : 8383 MILLICENT WAY
Second Line :
City : SHREVEPORT
State : LA
Zip : 71115-5207
Country : US
Telephone Number : 318-797-6661
Fax Number : 318-795-8512
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2005
Last Update Date : 01/08/2013

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