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General NPI Number Information
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NPI Number | 1174843643
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Entity Type | Individual
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Provider Name | MARK STEVEN GOTTLIEB D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/08/2010
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 1403 E SEGO LILY DR # 100B
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City | SANDY
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State | UT
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Zip | 84092-4350
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Country | US
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Telephone | 801-316-9620
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Fax | 801-316-9626
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Provider Business Mailing Address
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Address Line | PO BOX 35380
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City | LAS VEGAS
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State | NV
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Zip | 89133-5380
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Country | US
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Telephone | 801-316-9620
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Fax | 801-316-9626
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS007588L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DO2844
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 14197633-1204
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License Number State | UT
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