Basic Information
Provider Information
NPI: 1114969334
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JONES
FirstName: DONALD
MiddleName: GREGORY
NamePrefix:  
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 783311
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191783311
CountryCode: US
TelephoneNumber: 4848844500
FaxNumber: 4848840611
Practice Location
Address1: 1200 S CEDAR CREST BLVD
Address2:  
City: ALLENTOWN
State: PA
PostalCode: 181036202
CountryCode: US
TelephoneNumber: 6104028111
FaxNumber: 6104021698
Other Information
ProviderEnumerationDate: 06/12/2006
LastUpdateDate: 03/07/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000XOS014124PAY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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