Provider Demographics
NPI:1659405314
Name:UDY, MARK W (PA-C)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:W
Last Name:UDY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:617 E RIVERSIDE DR STE 301
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-8722
Mailing Address - Country:US
Mailing Address - Phone:435-216-7000
Mailing Address - Fax:435-216-7001
Practice Address - Street 1:617 E RIVERSIDE DR STE 301
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-8722
Practice Address - Country:US
Practice Address - Phone:435-216-7000
Practice Address - Fax:435-216-7001
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2023-03-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NVPA1599363AM0700X
UT6781192-1206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical