Provider Demographics
NPI:1508585423
Name:MARK L JEWELL MD PC
Entity Type:Organization
Organization Name:MARK L JEWELL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:L
Authorized Official - Last Name:JEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-683-3234
Mailing Address - Street 1:1200 EXECUTIVE PKWY STE 360
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2169
Mailing Address - Country:US
Mailing Address - Phone:541-683-3234
Mailing Address - Fax:541-683-8610
Practice Address - Street 1:1200 EXECUTIVE PKWY STE 360
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2169
Practice Address - Country:US
Practice Address - Phone:541-683-3234
Practice Address - Fax:541-683-8610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty