Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | 9412207-1205 | UT |
NPI | 1023244530 |
---|---|
Provider Name | Mark Edward Hamaker |
First Address | Salt Lake City, UT 84102-1959 |
Second Address | Salt Lake City, UT 84113-1103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2009 |
Last Update Date | 02/11/2021 |