Provider Demographics
NPI:1316334881
Name:JONES, RYAN DALE (MD, PHD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:DALE
Last Name:JONES
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 IMPERIAL CIR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-0132
Mailing Address - Country:US
Mailing Address - Phone:630-247-8514
Mailing Address - Fax:
Practice Address - Street 1:600 W CHICAGO AVE STE 510
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-2282
Practice Address - Country:US
Practice Address - Phone:630-247-8514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-22
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.144898207ZP0101X, 207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology