Provider Demographics
NPI:1215998471
Name:JONES, DAVID T (MD, PHD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:T
Last Name:JONES
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:10490 SW 20TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-7425
Mailing Address - Country:US
Mailing Address - Phone:954-474-0645
Mailing Address - Fax:954-474-0645
Practice Address - Street 1:300 S PARK RD STE 300
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-8353
Practice Address - Country:US
Practice Address - Phone:954-925-2740
Practice Address - Fax:954-923-8379
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0067178207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264746000Medicaid
FLG62663Medicare UPIN
FL264746000Medicaid