1902913833 NPI number — J.S. ROGER JONES MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902913833 NPI number — J.S. ROGER JONES MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

JONES

Provider First Name:

J.S.

Provider Middle Name:

ROGER

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1902913833

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

12/11/2014

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

2720 ST MARYS WAY

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

SALT LAKE CITY

Provider Business Mailing Address State Name:

UT

Provider Business Mailing Address Postal Code:

84108-2040

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

2720 ST MARYS WAY

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

SALT LAKE CITY

Provider Business Practice Location Address State Name:

UT

Provider Business Practice Location Address Postal Code:

84108-2040

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

801-581-9576

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

08/24/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207L00000X , with the licence number:  149650-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 401765 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
• Identifier: 870280408JO1 . This is a "EDUCATORS MUTUAL" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
• Identifier: 002967100 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
• Identifier: 416942 . This is a "DESERET MUTUAL" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
• Identifier: 4884 . This is a "HEALTHY U" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
• Identifier: QM0000032763 . This is a "ALTIUS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
• Identifier: 785959 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
• Identifier: 002085372 . This is a "FIRST HEALTH" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
• Identifier: 104778700 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
• Identifier: 2000040 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
• Identifier: 24132 . This is a "PEHP" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
• Identifier: 107005035101 . This is a "IHC" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
• Identifier: PRA01601 . This is a "MOLINA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".