Provider Demographics
NPI:1396704375
Name:JONES, PATRICK G (MD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:G
Last Name:JONES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 DESIARD ST
Mailing Address - Street 2:SUITE 355
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7319
Mailing Address - Country:US
Mailing Address - Phone:318-807-7875
Mailing Address - Fax:318-812-9997
Practice Address - Street 1:112 SAINT JOHN ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7322
Practice Address - Country:US
Practice Address - Phone:318-387-5681
Practice Address - Fax:318-322-9957
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA016846207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1353566Medicaid
LA5M748DD24Medicare PIN
LA5M748Medicare ID - Type Unspecified