MEDICARE: EVELYN MONTGOMERY 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	207N00000X	Dermatology Physician	27324	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00080586	OTHER	KY	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000324645	OTHER	KY	ANTHEM

General Provider Information

NPI Number	:	1982643797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVELYN MONTGOMERY JONES M.D.

Provider Business Mailing Address
First Line	:	2721 W PARK DR
Second Line	:
City	:	PADUCAH
State	:	KY
Zip	:	42001-9058
Country	:	US
Telephone Number	:	270-554-7540
Fax Number	:	270-554-0316

Provider Business Practice Location Address
First Line	:	2721 W PARK DR
Second Line	:
City	:	PADUCAH
State	:	KY
Zip	:	42001-9058
Country	:	US
Telephone Number	:	270-554-7540
Fax Number	:	270-554-0316

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	09/10/2014

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