Provider Demographics
NPI:1700846474
Name:JONES, MARK EDWARD (DO)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:EDWARD
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 1:5900 NW 86TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-2284
Mailing Address - Country:US
Mailing Address - Phone:515-276-6133
Mailing Address - Fax:515-334-7356
Practice Address - Street 1:5900 NW 86TH ST STE 100
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-2284
Practice Address - Country:US
Practice Address - Phone:515-276-6133
Practice Address - Fax:515-334-7356
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01694207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1700846474Medicaid
IA157784Medicaid
IA010049120Medicare PIN
IA157784Medicaid
IA719260400Medicare PIN
IA719260400Medicare PIN