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NPI Code Detail

MEDICARE: MARK FORD WILKINSON D.O.

MEDICARE:   MARK FORD WILKINSON  D.O.
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
1208600000XSurgery Physician11318316-1204UT

General Provider Information

NPI Number : 1083020622
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK FORD WILKINSON D.O.
Provider Business Mailing Address
First Line : 324 E 10TH AVE STE 200
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84103-2869
Country : US
Telephone Number : 801-831-5127
Fax Number :
Provider Business Practice Location Address
First Line : 324 E 10TH AVE STE 200
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84103-2869
Country : US
Telephone Number : 801-408-7500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2014
Last Update Date : 04/02/2020

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Directions to “ MARK FORD WILKINSON D.O.” Practice Location

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