Provider Demographics
NPI:1689611824
Name:JONES, MAX E (DPM)
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:E
Last Name:JONES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 S 1100 E
Mailing Address - Street 2:#115
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1213
Mailing Address - Country:US
Mailing Address - Phone:801-268-9415
Mailing Address - Fax:801-268-0423
Practice Address - Street 1:3920 S 1100 E
Practice Address - Street 2:#115
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1213
Practice Address - Country:US
Practice Address - Phone:801-268-9415
Practice Address - Fax:801-268-0423
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1017800501213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107005784102OtherIHC
UT5225273403001OtherBCBS
UTDMERCOther5663040001