Provider Demographics
NPI:1699956748
Name:JONES, AUDREY LEE (DO)
Entity type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:LEE
Last Name:JONES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:TX
Mailing Address - Zip Code:78516-2520
Mailing Address - Country:US
Mailing Address - Phone:956-325-3138
Mailing Address - Fax:956-601-0911
Practice Address - Street 1:803 MAIN ST
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:TX
Practice Address - Zip Code:78516-2520
Practice Address - Country:US
Practice Address - Phone:956-325-3138
Practice Address - Fax:956-601-0911
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2023-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5779207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138434911Medicaid
TX138434911Medicaid
TX8F2103Medicare PIN
TXE57357Medicare UPIN