Provider Demographics
NPI:1780623264
Name:JONES, GAIL (MD)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:JONES
Suffix:
Gender:F
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 901652
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44190-0001
Mailing Address - Country:US
Mailing Address - Phone:216-383-6776
Mailing Address - Fax:216-383-6745
Practice Address - Street 1:11110 KINSMAN RD #2
Practice Address - Street 2:
Practice Address - City:NEWBURY
Practice Address - State:OH
Practice Address - Zip Code:44065
Practice Address - Country:US
Practice Address - Phone:440-564-6666
Practice Address - Fax:440-564-6665
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI48826207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34824300Medicaid
OH2318021Medicaid
OH2318021Medicaid