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NPI Code Detail

MEDICARE: JACOB RAYMOND JONES

MEDICARE: JACOB RAYMOND JONES
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
1390200000XStudent in an Organized Health Care Education/Training ProgramIL

General Provider Information

NPI Number : 1649113788
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB RAYMOND JONES
Provider Business Mailing Address
First Line : 504 N GRANT ST
Second Line :
City : WESTMONT
State : IL
Zip : 60559-1509
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 815 MAIN ST STE C
Second Line :
City : PEORIA
State : IL
Zip : 61602-1080
Country : US
Telephone Number : 309-672-4977
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2026
Last Update Date : 04/13/2026

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Directions to “ JACOB RAYMOND JONES ” Practice Location

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