Provider Demographics
NPI:1104237171
Name:JONES, MAX ALLEN
Entity type:Individual
Prefix:
First Name:MAX
Middle Name:ALLEN
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:EUFAULA
Mailing Address - State:OK
Mailing Address - Zip Code:74432-3211
Mailing Address - Country:US
Mailing Address - Phone:405-200-5085
Mailing Address - Fax:918-339-5171
Practice Address - Street 1:69 ARROWHEAD LOOP
Practice Address - Street 2:
Practice Address - City:CANADIAN
Practice Address - State:OK
Practice Address - Zip Code:74425-5012
Practice Address - Country:US
Practice Address - Phone:918-339-5800
Practice Address - Fax:918-339-5840
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator