Basic Information
Provider Information
NPI: 1003001785
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JONES
FirstName: JACLYN
MiddleName: CINDA
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1245 S UTICA AVE
Address2:  
City: TULSA
State: OK
PostalCode: 741044214
CountryCode: US
TelephoneNumber: 9185792590
FaxNumber: 9185792599
Practice Location
Address1: 2250 DREW ST
Address2:  
City: CLEARWATER
State: FL
PostalCode: 337653305
CountryCode: US
TelephoneNumber: 7277977463
FaxNumber: 7277245689
Other Information
ProviderEnumerationDate: 09/06/2007
LastUpdateDate: 12/05/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207X00000XDO 2007008280MOY Allopathic & Osteopathic PhysiciansOrthopaedic Surgery 

No ID Information.


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