Provider Demographics
NPI:1477559490
Name:JONES, MARK R (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:JONES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:54 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-3050
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1057 MEDICAL PARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065
Practice Address - Country:US
Practice Address - Phone:573-348-2745
Practice Address - Fax:573-348-8279
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8G66207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO248084006Medicaid
MO080075910OtherRAILROAD MEDICARE
MO080075910OtherRAILROAD MEDICARE
MOE66082Medicare UPIN