Healthcare Provider Details

I. General information

NPI: 1245297688
Provider Name (Legal Business Name): MARK E MORITZ DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 E 3900 S STE 4D
SALT LAKE CITY UT
84124-1383
US

IV. Provider business mailing address

PO BOX 404
RIVERTON UT
84065-0404
US

V. Phone/Fax

Practice location:
  • Phone: 801-269-9939
  • Fax: 801-269-9949
Mailing address:
  • Phone: 801-269-9939
  • Fax: 801-405-7695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number326708-8907
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number326708-0501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: