Provider Demographics
NPI:1174519359
Name:JONES, PAUL CLINT (DPM)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:CLINT
Last Name:JONES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8305 SE MONTEREY AVE. #101
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97086
Mailing Address - Country:US
Mailing Address - Phone:503-652-1121
Mailing Address - Fax:503-652-2193
Practice Address - Street 1:8305 SE MONTEREY AVE #101
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97086
Practice Address - Country:US
Practice Address - Phone:503-652-1121
Practice Address - Fax:503-652-2193
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP - 183213ES0103X
WAPO 774213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1121722Medicaid
U83766Medicare UPIN
WAG8851866Medicare PIN