Provider Demographics
NPI:1972814895
Name:JOHN, JONES SAM (DO)
Entity type:Individual
Prefix:
First Name:JONES
Middle Name:SAM
Last Name:JOHN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 277711
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-7711
Mailing Address - Country:US
Mailing Address - Phone:954-908-5992
Mailing Address - Fax:954-951-1171
Practice Address - Street 1:7351 W. OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319
Practice Address - Country:US
Practice Address - Phone:954-908-5992
Practice Address - Fax:954-951-1171
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS11516207RN0300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology