Provider Demographics
NPI:1386645398
Name:MARK R ELKINS DPM PC
Entity Type:Organization
Organization Name:MARK R ELKINS DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:ELKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-253-6886
Mailing Address - Street 1:4019 W 12600 S
Mailing Address - Street 2:SUITE 120
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84096-7302
Mailing Address - Country:US
Mailing Address - Phone:801-253-6886
Mailing Address - Fax:801-253-6888
Practice Address - Street 1:4019 W 12600 S
Practice Address - Street 2:SUITE 120
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84096-7302
Practice Address - Country:US
Practice Address - Phone:801-253-6886
Practice Address - Fax:801-253-6888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13128213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT5346948-0501OtherPROFESSIONAL LICENSE
UT5346948-8907OtherCONTROLLED SUBSTANCE
UT5346948-0501OtherPROFESSIONAL LICENSE
UT000058015Medicare UPIN
UT5346948-8907OtherCONTROLLED SUBSTANCE