Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 164851-1205 | UT |
NPI | 1003138785 |
---|---|
Provider Name | Dr. Mark Carl Thomas |
First Address | South Jordan, UT 84095-7916 |
Second Address | South Jordan, UT 84095-7916 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2010 |
Last Update Date | 22/02/2010 |