Provider Demographics
NPI:1871751206
Name:JONES, RANDOLPH PERRY (MD)
Entity type:Individual
Prefix:DR
First Name:RANDOLPH
Middle Name:PERRY
Last Name:JONES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1530 E EDINGER AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-4915
Mailing Address - Country:US
Mailing Address - Phone:714-541-8464
Mailing Address - Fax:714-541-8461
Practice Address - Street 1:1530 E EDINGER
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705
Practice Address - Country:US
Practice Address - Phone:714-541-8464
Practice Address - Fax:714-541-8461
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC38951207QA0505X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine