Healthcare Provider Details

I. General information

NPI: 1336450832
Provider Name (Legal Business Name): EVAN JONES D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 12/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1248 E 90 N SUITE 300
AMERICAN FORK UT
84003-2956
US

IV. Provider business mailing address

585 N 500 W
PROVO UT
84601-1548
US

V. Phone/Fax

Practice location:
  • Phone: 801-756-9635
  • Fax: 801-216-8357
Mailing address:
  • Phone: 801-374-1801
  • Fax: 801-216-8357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number8919719-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: