Basic Information
| Provider Information | |||||||||
| NPI: | 1326090465 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ORTON | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | DOUGLAS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 727 | ||||||||
| Address2: | |||||||||
| City: | BRIGHAM CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 843020727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4357340101 | ||||||||
| FaxNumber: | 4357340103 | ||||||||
| Practice Location | |||||||||
| Address1: | 5475 S 500 E | ||||||||
| Address2: | |||||||||
| City: | OGDEN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 844056905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014792392 | ||||||||
| FaxNumber: | 8014792396 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 04/03/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0105X | 52916161205 | UT | N | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology/Laboratory Medicine | 207ZP0102X | 52916161205 | UT | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.