MEDICARE: ROBERT G. JONES M.D.

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	207RG0100X	Gastroenterology Physician	4985419-1205	UT

General Provider Information

NPI Number	:	1164465647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT G. JONES M.D.

Provider Business Mailing Address
First Line	:	6360 S 3000 E
Second Line	:	#220
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-6923
Country	:	US
Telephone Number	:	801-944-3189
Fax Number	:	801-944-3180

Provider Business Practice Location Address
First Line	:	6360 S 3000 E
Second Line	:	#310
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-6923
Country	:	US
Telephone Number	:	801-944-3189
Fax Number	:	801-944-3180

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

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	06/09/2015

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