Provider Information for 1689080822
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JOSE ANTONIO JONES
Sex: Male
NPI: 1689080822
Last Updated: 2014-07-09
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1689080822 | ||||||||
| Enumeration Date | 2014-07-09 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1410 ALBERTA DR. ST. CHARLES, MO 63303 United States Phone: 636-578-0281 | Fax: | ||||||||
| Primary Practice Address | 1410 ALBERTA DR SAINT CHARLES, MO 63303-3608 United States Phone: 636-578-0281 | Fax: | ||||||||
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