Provider Demographics
NPI:1063424331
Name:JONES, TIMOTHY R (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:R
Last Name:JONES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3046
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-0746
Mailing Address - Country:US
Mailing Address - Phone:580-249-3898
Mailing Address - Fax:580-234-9625
Practice Address - Street 1:330 S 5TH ST STE 401
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5863
Practice Address - Country:US
Practice Address - Phone:580-249-3898
Practice Address - Fax:580-234-9625
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA256844207Y00000X
MOR4P52208200000X
OH35099577208200000X
OK31852207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2759638OtherCIGNA PROVIDER NUMBER
MO142569OtherHEALTHLINK PROVIDER NUMBE
MO4206783OtherAETNA PROVIDER NUMBER
MO113393OtherBC/BS PROVIDER NUMBER
MO142569OtherHEALTHLINK PROVIDER NUMBE
E89354Medicare UPIN
MO2759638OtherCIGNA PROVIDER NUMBER