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Individual

MR. ROBERT RANDALL JONES JR.

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1951 BENCH RD, #C, POCATELLO, ID 83201
(208) 238-3377
(208) 238-8091
Mailing address
1951 BENCH RD, #C, POCATELLO, ID 83201
(208) 238-3377
(208) 238-8091

Taxonomy

Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
M6955
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010001691
B/S
ID
05
000223700
ID
01
11344491
MEDICARE PTAN
ID
01
180029065
R/R MEDICARE
01
19554
B/C
ID
Enumeration date
08/26/2006
Last updated
06/08/2023
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