Provider Demographics
NPI:1487675120
Name:JONES, HENRY M (MD)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:M
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 1:2015 JACKSON STREET
Mailing Address - Street 2:RADIOLOGY DEPT
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46016-4339
Mailing Address - Country:US
Mailing Address - Phone:765-649-2511
Mailing Address - Fax:
Practice Address - Street 1:2015 JACKSON STREET
Practice Address - Street 2:RADIOLOGY DEPT
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-4339
Practice Address - Country:US
Practice Address - Phone:765-649-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50696012085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C24336Medicare UPIN
506960IMedicare ID - Type Unspecified