Provider Demographics
NPI:1740283555
Name:JONES, ANDREW F (DO)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:F
Last Name:JONES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 566
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:ID
Mailing Address - Zip Code:83522-0566
Mailing Address - Country:US
Mailing Address - Phone:208-962-3052
Mailing Address - Fax:
Practice Address - Street 1:1775 KEUTERVILLE ROAD
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:ID
Practice Address - Zip Code:83522-9750
Practice Address - Country:US
Practice Address - Phone:208-962-3052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID0-89207Q00000X
IDO-89207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002285900Medicaid
ID1300943Medicare ID - Type UnspecifiedIDAHO MEDICARE PROV #
IDE19319Medicare UPIN