Healthcare Provider Details

I. General information

NPI: 1942260617
Provider Name (Legal Business Name): MARK V REICHMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2006
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5171 COTTONWOOD ST SUITE 950
MURRAY UT
84107-5704
US

IV. Provider business mailing address

2191 E PHEASANT WAY
HOLLADAY UT
84121-1310
US

V. Phone/Fax

Practice location:
  • Phone: 801-507-9555
  • Fax: 801-507-9550
Mailing address:
  • Phone: 801-403-3074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number1732781205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: