MEDICARE: MARK CHRISTIAN ROBISON 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
1	208000000X	Pediatrics Physician	170377-1205	UT
2	208000000X	Pediatrics Physician	170377-8905	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396737490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK CHRISTIAN ROBISON MD

Provider Business Mailing Address
First Line	:	1982 E VISCOUNTI CV
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84093-1059
Country	:	US
Telephone Number	:	612-990-6018
Fax Number	:

Provider Business Practice Location Address
First Line	:	1982 E VISCOUNTI CV
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84093-1059
Country	:	US
Telephone Number	:	612-990-6018
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	02/05/2020

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