Provider Demographics
NPI:1750837779
Name:REINAUER, MALLORI BETH (MD)
Entity Type:Individual
Prefix:DR
First Name:MALLORI
Middle Name:BETH
Last Name:REINAUER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MALLORI
Other - Middle Name:BETH
Other - Last Name:JIRIKOVIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30 N 1900 E RM 3C444
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132-2501
Mailing Address - Country:US
Mailing Address - Phone:801-581-3622
Mailing Address - Fax:
Practice Address - Street 1:50 N MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0001
Practice Address - Country:US
Practice Address - Phone:801-581-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11420227-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology