Provider Demographics
NPI:1538177084
Name:JONES, MICHAEL JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAMES
Last Name:JONES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2601 KENTUCKY AVENUE
Mailing Address - Street 2:SUITE #202
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-3825
Mailing Address - Country:US
Mailing Address - Phone:270-538-5300
Mailing Address - Fax:270-538-5308
Practice Address - Street 1:2601 KENTUCKY AVENUE
Practice Address - Street 2:SUITE #202
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3825
Practice Address - Country:US
Practice Address - Phone:270-538-5300
Practice Address - Fax:270-538-5308
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY200812086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01720731101Medicaid
KY64200819Medicaid
KY0645303Medicare PIN