Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 5135057-1205 | UT |
Y | 208600000X | Surgeon | 5135057-1205 | UT |
N | 2086X0206X | Surgical Oncologist | 153899 | MA |
N | 2086X0206X | Surgical Oncologist | 5135057-1205 | UT |
NPI | 1003889262 |
---|---|
Provider Name | Mark John Ott |
First Address | Murray, UT 84107-6767 |
Second Address | Murray, UT 84107-6767 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2006 |
Last Update Date | 10/01/2022 |