Provider Demographics
NPI:1821093345
Name:JONES, MARK W (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:W
Last Name:JONES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 W WACKERLY ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-6921
Mailing Address - Country:US
Mailing Address - Phone:989-698-3033
Mailing Address - Fax:989-792-8814
Practice Address - Street 1:2520 W WACKERLY ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6921
Practice Address - Country:US
Practice Address - Phone:989-698-3033
Practice Address - Fax:989-792-8814
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMJ064490174400000X
MI4301064490207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4514736Medicaid
MI0P12600Medicare ID - Type UnspecifiedMEDICARE
MI4514736Medicaid