Provider Demographics
NPI:1578527990
Name:MERING, MARK EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:EDWARD
Last Name:MERING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6440 S MILLROCK DR
Mailing Address - Street 2:#175
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-5589
Mailing Address - Country:US
Mailing Address - Phone:801-930-3000
Mailing Address - Fax:
Practice Address - Street 1:6440 S MILLROCK DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-5589
Practice Address - Country:US
Practice Address - Phone:801-630-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM5758207Q00000X
WI29273207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID003838100Medicaid
1124184Medicare ID - Type UnspecifiedCIGNA
1124185Medicare ID - Type UnspecifiedCIGNA
1124182Medicare ID - Type UnspecifiedCIGNA
1124183Medicare ID - Type UnspecifiedCIGNA
ID003838100Medicaid