Provider Demographics
NPI:1992953921
Name:JONES, WILLIAM DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DAVID
Last Name:JONES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1554 RIVER PINES DR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-5648
Mailing Address - Country:US
Mailing Address - Phone:920-465-7856
Mailing Address - Fax:
Practice Address - Street 1:1554 RIVER PINES DR
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-5648
Practice Address - Country:US
Practice Address - Phone:920-465-7856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15853-020207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIAJ3538569OtherDEA REGISTRATION