Healthcare Provider Details

I. General information

NPI: 1386645398
Provider Name (Legal Business Name): MARK R ELKINS DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 08/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4019 W 12600 S SUITE 120
RIVERTON UT
84096-7302
US

IV. Provider business mailing address

4019 W 12600 S SUITE 120
RIVERTON UT
84096-7302
US

V. Phone/Fax

Practice location:
  • Phone: 801-253-6886
  • Fax: 801-253-6888
Mailing address:
  • Phone: 801-253-6886
  • Fax: 801-253-6888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number13128
License Number StateUT

VIII. Authorized Official

Name: MARK R ELKINS
Title or Position: PRESIDENT
Credential:
Phone: 801-253-6886