MEDICARE: MARK BRIAN JONES PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	PA20750	CA
2	363AS0400X	Surgical Physician Assistant	PA.0000722	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144370933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK BRIAN JONES PA-C

Provider Business Mailing Address
First Line	:	4105 BRIARGATE PKWY
Second Line	:	STE 300
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3480
Country	:	US
Telephone Number	:	719-776-7846
Fax Number	:	719-776-3456

Provider Business Practice Location Address
First Line	:	4105 BRIARGATE PKWY
Second Line	:	STE 300
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3480
Country	:	US
Telephone Number	:	719-776-7846
Fax Number	:	719-776-3456

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	10/17/2016

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