Provider Demographics
NPI:1851386767
Name:JONES, MARK R (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:R
Last Name:JONES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:4500 CHURCHMAN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1143
Practice Address - Country:US
Practice Address - Phone:502-363-3100
Practice Address - Fax:502-363-1110
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY303942085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1052405OtherPASSPORT HEALTH PROV. #
KYP01778546OtherRR MEDICARE
KY000001043251OtherANTHEM BCBS
KY1052404OtherPASSPORT HEALTH GRP #
KY4675796OtherAETNA OTHER #
KY2092988OtherAETNA
KY4541164OtherCIGNA - LKO
KY000000039660OtherANTHEM BCBS PROV. #
KY64303944Medicaid
IN200833760Medicaid
FL50115896OtherUNIVERSITY HEALTHCARE
KY1178107OtherGATEWAY HEALTH
KY2092988OtherAETNA HMO #
KY4541164OtherCIGNA
KY598967OtherSTERLING HEALTH
KY92004007OtherRAILROAD MEDICARE
FL50115896OtherUNIVERSITY HEALTHCARE
KY92004007OtherRAILROAD MEDICARE
IN200833760Medicaid