Provider Demographics
NPI:1588663645
Name:JONES, BRENDA FAYE (MD)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:FAYE
Last Name:JONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 W 200 N STE 200
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-7386
Mailing Address - Country:US
Mailing Address - Phone:435-986-2020
Mailing Address - Fax:435-652-1516
Practice Address - Street 1:330 N SANDHILL BLVD STE A
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:NV
Practice Address - Zip Code:89027-4779
Practice Address - Country:US
Practice Address - Phone:702-346-2950
Practice Address - Fax:702-346-3795
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH55641207W00000X
NV17844207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP01296262OtherRAILROAD MEDICARE - MHCPI
NV1588663645Medicaid
OH0672106Medicaid
UT1588663645Medicaid
WV0095420000Medicaid
OHP01296262OtherRAILROAD MEDICARE - MHCPI
OH9282721Medicare ID - Type Unspecified
OHH140441Medicare PIN