Provider Demographics
NPI:1619981487
Name:JONES, WILLIAM TERRY (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:TERRY
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 1:679 E COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1049
Mailing Address - Country:US
Mailing Address - Phone:317-807-1241
Mailing Address - Fax:317-859-4268
Practice Address - Street 1:679 E COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1049
Practice Address - Country:US
Practice Address - Phone:317-859-7222
Practice Address - Fax:317-859-7220
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01040300A208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100194370OtherMEDICAID GROUP NUMBER
1487680518OtherGROUP NPI NUMBER
IN200003610Medicaid
IN340015548OtherMEDICARE RAILROAD
IN000000091690OtherANTHEM PROVIDER NUMBER
IN340015550OtherMEDICARE RAILROAD
1487680518OtherGROUP NPI NUMBER
IN100194370OtherMEDICAID GROUP NUMBER
IN069360AMedicare PIN
INF27884Medicare UPIN
IN069340AMedicare PIN