Healthcare Provider Details

I. General information

NPI: 1275925752
Provider Name (Legal Business Name): MARK M MCOMIE AU.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2015
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 W 2100 S STE 120
SALT LAKE CITY UT
84115-1855
US

IV. Provider business mailing address

140 W 2100 S STE 120
SALT LAKE CITY UT
84115-1855
US

V. Phone/Fax

Practice location:
  • Phone: 801-484-3277
  • Fax: 801-666-2027
Mailing address:
  • Phone: 801-484-3277
  • Fax: 801-666-2027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: