Healthcare Provider Details

I. General information

NPI: 1922120468
Provider Name (Legal Business Name): MARK CLIFFTON TEMPLEMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 01/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5063 S COTTONWOOD ST SUITE 160
MURRAY UT
84107-6766
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-507-1850
  • Fax: 801-507-1875
Mailing address:
  • Phone: 801-507-1850
  • Fax: 801-507-1875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number183629-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: