Provider Demographics
NPI:1043259534
Name:JONES, AMY KEEBLER (MD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:KEEBLER
Last Name:JONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6251 GOOD SAMARITAN WAY
Mailing Address - Street 2:SUITE 210C
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-5253
Mailing Address - Country:US
Mailing Address - Phone:937-233-3910
Mailing Address - Fax:937-233-8389
Practice Address - Street 1:6251 GOOD SAMARITAN WAY
Practice Address - Street 2:SUITE 210C
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-5253
Practice Address - Country:US
Practice Address - Phone:937-233-3910
Practice Address - Fax:937-233-8389
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.080432208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2317013Medicaid