Provider Demographics
NPI:1427083187
Name:JONES, CLIFFORD RAY (MD)
Entity type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:RAY
Last Name:JONES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:C.
Other - Middle Name:RAY
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3302 RENNER DR STE A
Mailing Address - Street 2:
Mailing Address - City:FORTUNA
Mailing Address - State:CA
Mailing Address - Zip Code:95540-7103
Mailing Address - Country:US
Mailing Address - Phone:707-725-3318
Mailing Address - Fax:707-725-9396
Practice Address - Street 1:3302 RENNER DR STE A
Practice Address - Street 2:
Practice Address - City:FORTUNA
Practice Address - State:CA
Practice Address - Zip Code:95540-7103
Practice Address - Country:US
Practice Address - Phone:707-725-3318
Practice Address - Fax:707-725-9396
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4125207Q00000X
CAC42987207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1699836981Medicaid
CARHM53808FMedicaid
CAC17623Medicare UPIN
CA553808Medicare ID - Type UnspecifiedRURAL HEALTH CLINIC #
CA1699836981Medicaid