Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 01025378A | IN |
N | 207RC0000X | Internist - Cardiovascular Disease | 01025378A | IN |
NPI | 1790755924 |
---|---|
Provider Name | Mark A. Jones |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Fort Wayne, IN 46804-4140 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2006 |
Last Update Date | 27/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000087412 | ANTHEM (01) | IN |
0494559 | (05) | OH |
100054160 | (05) | IN |
C03589 | (02) | IN |
P00783715 | RAILROAD (01) |