Provider Demographics
NPI:1518178763
Name:JONES, JONATHAN OWEN (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:OWEN
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:PO BOX 844088
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4088
Mailing Address - Country:US
Mailing Address - Phone:505-609-2243
Mailing Address - Fax:505-609-2259
Practice Address - Street 1:2500 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-4504
Practice Address - Country:US
Practice Address - Phone:505-609-6830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-26
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2010-0239208VP0000X
NMMD2010-023207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO85958573Medicaid
UT1518178763Medicaid
AZ537713Medicaid
NM70433569Medicaid
NMNMA100650Medicare PIN
NMNMA101371 PAINMedicare PIN