Provider Demographics
NPI:1336194414
Name:JONES, KEVIN C (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:C
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 1:129 CARRIAGE LAMP WAY
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-1903
Mailing Address - Country:US
Mailing Address - Phone:904-728-8825
Mailing Address - Fax:
Practice Address - Street 1:129 CARRIAGE LAMP WAY
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-1903
Practice Address - Country:US
Practice Address - Phone:904-728-8825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA537642085N0700X
NY205663-12085N0700X
SCMMD.28538 MD2085N0700X
FLME 889072085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY020830021Medicaid
NY020830021Medicaid