Provider Demographics
NPI:1801067731
Name:MICHAEL D JONES MD PC
Entity type:Organization
Organization Name:MICHAEL D JONES MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-433-2873
Mailing Address - Street 1:1868 WEST 9800 SOUTH
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095
Mailing Address - Country:US
Mailing Address - Phone:801-433-2873
Mailing Address - Fax:801-433-5734
Practice Address - Street 1:1868 W 9800 S
Practice Address - Street 2:100
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095
Practice Address - Country:US
Practice Address - Phone:801-433-2873
Practice Address - Fax:801-433-5734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3732281205261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000012595OtherINDIVIDUAL MEDICARE PIN
UT000012595OtherINDIVIDUAL MEDICARE PIN