Provider Demographics
NPI:1730168964
Name:JONES, MARK CLAYTON (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:CLAYTON
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 1:1347 TIMBERLAKE RD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-4125
Mailing Address - Country:US
Mailing Address - Phone:760-774-9286
Mailing Address - Fax:
Practice Address - Street 1:1347 TIMBERLAKE RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-4125
Practice Address - Country:US
Practice Address - Phone:760-774-9286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01033304A2084N0400X
MEMD200232084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3001440Medicaid
TN3001440Medicaid
TNC25878Medicare UPIN