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NPI Code Detail

MEDICARE: MR. DELVIN R JONES M.S., P.A.-C

MEDICARE: MR. DELVIN R JONES M.S., P.A.-C
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
1363AM0700XMedical Physician AssistantPA10002281WA
2363A00000XPhysician AssistantPA10002281WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1679577241
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DELVIN R JONES M.S., P.A.-C
Provider Business Mailing Address
First Line : PO BOX 4825
Second Line :
City : PORTLAND
State : OR
Zip : 97208-4825
Country : US
Telephone Number : 360-882-2778
Fax Number :
Provider Business Practice Location Address
First Line : 2005 W MAIN ST STE 120
Second Line :
City : BATTLE GROUND
State : WA
Zip : 98604-4311
Country : US
Telephone Number : 360-882-2778
Fax Number : 360-604-1690
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2005
Last Update Date : 06/09/2021

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