Provider Demographics
NPI:1902913833
Name:JONES, J.S. ROGER (MD)
Entity Type:Individual
Prefix:
First Name:J.S.
Middle Name:ROGER
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 1:2720 ST MARYS WAY
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-2040
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2720 ST MARYS WAY
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-2040
Practice Address - Country:US
Practice Address - Phone:801-581-9576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT149650-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT401765Medicaid
UT870280408JO1OtherEDUCATORS MUTUAL
ID002967100Medicaid
UT416942OtherDESERET MUTUAL
UT4884OtherHEALTHY U
UTQM0000032763OtherALTIUS
AZ785959Medicaid
UT002085372OtherFIRST HEALTH
WY104778700Medicaid
UT2000040OtherUNITED HEALTHCARE
UT24132OtherPEHP
UT107005035101OtherIHC
UTPRA01601OtherMOLINA
UT4884OtherHEALTHY U
MT401765Medicaid