Provider Demographics
NPI:1144370933
Name:JONES, MARK BRIAN (PA-C)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:BRIAN
Last Name:JONES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4105 BRIARGATE PKWY
Mailing Address - Street 2:STE 300
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3480
Mailing Address - Country:US
Mailing Address - Phone:719-776-7846
Mailing Address - Fax:719-776-3456
Practice Address - Street 1:4105 BRIARGATE PKWY
Practice Address - Street 2:STE 300
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3480
Practice Address - Country:US
Practice Address - Phone:719-776-7846
Practice Address - Fax:719-776-3456
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20750363AS0400X
COPA.0000722363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1841240454Medicaid
CA1841240454Medicare NSC