Provider Demographics
NPI:1912002353
Name:JONES, MARK LEONARD (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:LEONARD
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 1:750 W 800 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-3660
Mailing Address - Country:US
Mailing Address - Phone:801-714-6140
Mailing Address - Fax:
Practice Address - Street 1:750 W 800 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-3660
Practice Address - Country:US
Practice Address - Phone:800-748-4868
Practice Address - Fax:801-733-5618
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT183124-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT52946OtherHEALTHY U
UT107008396102OtherIHC
UT870525882JO1OtherEDUCATORS MUTUAL
UT341510OtherDESERET MUTUAL
UT47504OtherPEHP
UTPRA01546OtherMOLINA
UTQM0000076595OtherALTIUS
UTG67895Medicare UPIN