Provider Demographics
NPI:1174893689
Name:JONES, JAMES EDWARD SR (DO)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:JONES
Suffix:SR
Gender:M
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:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-0001
Mailing Address - Country:US
Mailing Address - Phone:636-397-0079
Mailing Address - Fax:
Practice Address - Street 1:23 GRANT DR
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1208
Practice Address - Country:US
Practice Address - Phone:636-397-0079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-01
Last Update Date:2012-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO31005208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice