Provider Demographics
NPI:1144330572
Name:JONES, JERRY TRAVIS (MD)
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:TRAVIS
Last Name:JONES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JERRY
Other - Middle Name:T
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3031 W MARCH LN STE 134
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-6578
Mailing Address - Country:US
Mailing Address - Phone:209-951-4666
Mailing Address - Fax:209-951-5829
Practice Address - Street 1:3031 W MARCH LN STE 134
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-6578
Practice Address - Country:US
Practice Address - Phone:209-951-4666
Practice Address - Fax:209-951-5829
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA238382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A238380Medicaid
00A238380Medicare ID - Type Unspecified
CA00A238380Medicaid