MEDICARE: MR. EDWARD DUANE 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	18051	OK

General Provider Information

NPI Number	:	1639139793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDWARD DUANE JONES M.D.

Provider Business Mailing Address
First Line	:	5701 N. PORTLAND, SUITE 105
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-1670
Country	:	US
Telephone Number	:	405-949-6401
Fax Number	:	405-946-4283

Provider Business Practice Location Address
First Line	:	5701 N. PORTLAND, SUITE 105
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-1670
Country	:	US
Telephone Number	:	405-949-6401
Fax Number	:	405-946-4283

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	08/11/2010

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