Provider Demographics
NPI:1366498818
Name:RHOLL, MARK ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALLEN
Last Name:RHOLL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:275 E 200 S
Mailing Address - Street 2:VISTA STAFFING SOLUTIONS
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-2002
Mailing Address - Country:US
Mailing Address - Phone:800-366-1884
Mailing Address - Fax:866-360-6021
Practice Address - Street 1:275 E 200 S
Practice Address - Street 2:VISTA STAFFING SOLUTIONS
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-2002
Practice Address - Country:US
Practice Address - Phone:800-366-1884
Practice Address - Fax:866-360-6021
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH10371207Q00000X
AK7512207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30011548Medicaid
NHB56022Medicare UPIN
NHRE4907Medicare ID - Type Unspecified