Provider Demographics
NPI:1598743973
Name:JONES, ALAN C (DO)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:C
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 1:576 E HIGHWAY 138 SUITE 210
Mailing Address - Street 2:
Mailing Address - City:STANSBURY PARK
Mailing Address - State:UT
Mailing Address - Zip Code:84074-4028
Mailing Address - Country:US
Mailing Address - Phone:801-893-4905
Mailing Address - Fax:801-849-1801
Practice Address - Street 1:576 E HIGHWAY 138 SUITE 210
Practice Address - Street 2:
Practice Address - City:STANSBURY PARK
Practice Address - State:UT
Practice Address - Zip Code:84074-4028
Practice Address - Country:US
Practice Address - Phone:801-893-4905
Practice Address - Fax:801-849-1801
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1143207YS0123X
UT6004387-1204207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1017911Medicaid
NV100503480Medicaid
NVV38961Medicare ID - Type Unspecified