Provider Demographics
NPI:1619958345
Name:ROGERS, MARK F (DPM)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:F
Last Name:ROGERS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1248 E 90 N STE 101
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2954
Mailing Address - Country:US
Mailing Address - Phone:801-756-4200
Mailing Address - Fax:801-756-8252
Practice Address - Street 1:1248 E 90 N STE 101
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2954
Practice Address - Country:US
Practice Address - Phone:801-756-4200
Practice Address - Fax:801-756-8252
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT102652-0501213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTT77925Medicare UPIN