Healthcare Provider Details

I. General information

NPI: 1598743973
Provider Name (Legal Business Name): ALAN C JONES D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

576 E HIGHWAY 138 SUITE 210
STANSBURY PARK UT
84074-4028
US

IV. Provider business mailing address

576 E HIGHWAY 138 SUITE 210
STANSBURY PARK UT
84074-4028
US

V. Phone/Fax

Practice location:
  • Phone: 801-893-4905
  • Fax: 801-849-1801
Mailing address:
  • Phone: 801-893-4905
  • Fax: 801-849-1801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number1143
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number6004387-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: