Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 6004387-1204 | UT |
N | 207YS0123X | Facial Plastic Surgeon | 1143 | NV |
NPI | 1598743973 |
---|---|
Provider Name | Alan C Jones |
First Address | Stansbury Park, UT 84074-4028 |
Second Address | Stansbury Park, UT 84074-4028 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2006 |
Last Update Date | 02/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100503480 | (05) | NV |
1017911 | (05) | UT |