Provider Demographics
NPI:1770540619
Name:JONES, GARY LEE (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:LEE
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 1:272 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:IVINS
Mailing Address - State:UT
Mailing Address - Zip Code:84738-6456
Mailing Address - Country:US
Mailing Address - Phone:435-986-2300
Mailing Address - Fax:435-634-1320
Practice Address - Street 1:272 E CENTER ST
Practice Address - Street 2:
Practice Address - City:IVINS
Practice Address - State:UT
Practice Address - Zip Code:84738-6456
Practice Address - Country:US
Practice Address - Phone:435-986-2300
Practice Address - Fax:435-634-1320
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT179965-12052084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E93297Medicare UPIN
UT005561613Medicare PIN