MEDICARE: GARY R 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	207VE0102X	Reproductive Endocrinology Physician	4301054590	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	036.141586	OTHER	IL	IL MEDICAL LIC

General Provider Information

NPI Number	:	1699753152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY R JONES MD

Provider Business Mailing Address
First Line	:	PO BOX 673739
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48267-3739
Country	:	US
Telephone Number	:	313-299-6650
Fax Number	:	313-299-6651

Provider Business Practice Location Address
First Line	:	30 TOWER CT STE F
Second Line	:
City	:	GURNEE
State	:	IL
Zip	:	60031-3322
Country	:	US
Telephone Number	:	847-662-1818
Fax Number	:

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

Provider Enumeration Date	:	01/05/2006
Last Update Date	:	10/09/2018

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