Provider Demographics
NPI:1215956768
Name:JONES, MICHAEL D (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
Last Name:JONES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3645 ENDICOTT DR
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-6912
Mailing Address - Country:US
Mailing Address - Phone:801-360-8122
Mailing Address - Fax:
Practice Address - Street 1:3645 ENDICOTT DR
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-6912
Practice Address - Country:US
Practice Address - Phone:801-360-8122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6890717-1205207P00000X
IN01055853A207P00000X
COCDRH.0001899207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT6890717120001OtherBCBS OF UTAH
UT6890717120001OtherBCBS OF UTAH
UT000063803Medicare PIN