Provider Demographics
NPI:1366437402
Name:JONES, TIMOTHY HOLLISTER (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:HOLLISTER
Last Name:JONES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:AVILA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93424-0159
Mailing Address - Country:US
Mailing Address - Phone:805-556-7006
Mailing Address - Fax:805-439-1482
Practice Address - Street 1:6621 BAY LAUREL PL STE A
Practice Address - Street 2:
Practice Address - City:AVILA BEACH
Practice Address - State:CA
Practice Address - Zip Code:93424-3504
Practice Address - Country:US
Practice Address - Phone:805-556-7006
Practice Address - Fax:805-439-1482
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA55265207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1497116701OtherNPI TIMOTHYJONES MD INC
CAA55265OtherSTATE LICENSE
CB254654OtherPTAN