Basic Information
| Provider Information | |||||||||
| NPI: | 1184688533 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHRISTIAN | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5546 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802175546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013976200 | ||||||||
| FaxNumber: | 8013976200 | ||||||||
| Practice Location | |||||||||
| Address1: | 185 S 400 E | ||||||||
| Address2: | STE 100 | ||||||||
| City: | BOUNTIFUL | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840104801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013976200 | ||||||||
| FaxNumber: | 8013976201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2006 | ||||||||
| LastUpdateDate: | 01/18/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 58481571205 | UT | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.