Provider Demographics
NPI:1639245855
Name:JEWELL, MARK L (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:L
Last Name:JEWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
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 1:10 COBURG RD STE 300
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-7481
Practice Address - Country:US
Practice Address - Phone:541-683-3234
Practice Address - Fax:541-683-8610
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR21824-8Medicaid
OR21824-8Medicaid
ORC92964Medicare UPIN