Healthcare Provider Details

I. General information

NPI: 1922065598
Provider Name (Legal Business Name): MARY D TIPTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3570 W 9000 S STE 220
WEST JORDAN UT
84088-8873
US

IV. Provider business mailing address

3584 W 9000 S STE 404
WEST JORDAN UT
84088-5712
US

V. Phone/Fax

Practice location:
  • Phone: 801-890-3837
  • Fax: 801-743-7596
Mailing address:
  • Phone: 801-890-3837
  • Fax: 801-743-7596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5934303-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: