MEDICARE: MAX E. JONES D.P.M.

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	213ES0103X	Foot & Ankle Surgery Podiatrist	1017800501	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	107005784102	OTHER	UT	IHC
2	5225273403001	OTHER	UT	BCBS
3	DMERC	OTHER	UT	5663040001

General Provider Information

NPI Number	:	1689611824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAX E. JONES D.P.M.

Provider Business Mailing Address
First Line	:	3920 S 1100 E
Second Line	:	#115
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-1213
Country	:	US
Telephone Number	:	801-268-9415
Fax Number	:	801-268-0423

Provider Business Practice Location Address
First Line	:	3920 S 1100 E
Second Line	:	#115
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-1213
Country	:	US
Telephone Number	:	801-268-9415
Fax Number	:	801-268-0423

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

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	07/08/2007

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