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NPI Code Detail

MEDICARE: MARY CAITLIN INDART MD

MEDICARE: MARY CAITLIN INDART MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology Physician13352416-1205UT

General Provider Information

NPI Number : 1063075612
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY CAITLIN INDART MD
Provider Business Mailing Address
First Line : 2854 E ETIENNE WAY
Second Line :
City : SANDY
State : UT
Zip : 84093-1115
Country : US
Telephone Number : 208-989-9373
Fax Number :
Provider Business Practice Location Address
First Line : 433 E 8TH ST
Second Line :
City : PORT ANGELES
State : WA
Zip : 98362-6219
Country : US
Telephone Number : 360-565-0999
Fax Number : 360-565-0591
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2019
Last Update Date : 04/22/2026

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Directions to “ MARY CAITLIN INDART MD” Practice Location

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