Provider Demographics
NPI:1063945517
Name:DONALD R JONES ENTERPRISES, LLC
Entity type:Organization
Organization Name:DONALD R JONES ENTERPRISES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:JONES
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:573-429-7677
Mailing Address - Street 1:RR 1 BOX 182
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63967-9722
Mailing Address - Country:US
Mailing Address - Phone:573-429-7677
Mailing Address - Fax:
Practice Address - Street 1:225 PHYSICIANS PARK STE 300
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-3930
Practice Address - Country:US
Practice Address - Phone:573-785-0313
Practice Address - Fax:573-727-0079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000146677207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO204888101Medicaid
MOH12165Medicare UPIN