Provider Demographics
NPI:1104709161
Name:JONES, REGINALD EPHRAM
Entity type:Individual
Prefix:
First Name:REGINALD
Middle Name:EPHRAM
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 HUBBARD ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48209-3329
Mailing Address - Country:US
Mailing Address - Phone:313-519-4464
Mailing Address - Fax:
Practice Address - Street 1:2109 HUBBARD ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48209-3329
Practice Address - Country:US
Practice Address - Phone:313-519-4464
Practice Address - Fax:313-519-4464
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center