Basic Information
Provider Information
NPI: 1437686268
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JONES
FirstName: NELROY
MiddleName: G
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 11100 EUCLID AVE
Address2:  
City: CLEVELAND
State: OH
PostalCode: 441061716
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 630 E RIVER ST
Address2:  
City: ELYRIA
State: OH
PostalCode: 440355902
CountryCode: US
TelephoneNumber: 4403297500
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/11/2017
LastUpdateDate: 06/04/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/04/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
207R00000X35.139999OHY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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