Provider Demographics
NPI:1215197488
Name:MAYR, MARK A (RD)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:A
Last Name:MAYR
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 S RIVER RD STE D1100
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-5522
Mailing Address - Country:US
Mailing Address - Phone:435-656-0857
Mailing Address - Fax:
Practice Address - Street 1:720 S RIVER RD STE D1100
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-5522
Practice Address - Country:US
Practice Address - Phone:435-656-0857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT69782354901133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal