Provider Demographics
NPI:1871838268
Name:MARK S. NAISBITT, MD, PC
Entity Type:Organization
Organization Name:MARK S. NAISBITT, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:NAISBITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-392-1401
Mailing Address - Street 1:3460 BAKER DR
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-1310
Mailing Address - Country:US
Mailing Address - Phone:801-392-1401
Mailing Address - Fax:
Practice Address - Street 1:4401 HARRISON BLVD
Practice Address - Street 2:MCKAY DEE HOSPITAL
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3195
Practice Address - Country:US
Practice Address - Phone:801-589-2006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT184191-1205207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT20167OtherDESERET MUTUAL
UT050041375OtherMEDICARE ID-RAILROAD MEDICARE
UT107005583101OtherIHC
UT2090168OtherUNITED HEALTHCARE
NV100501270Medicaid
UT8597445OtherWORKERS COMP
UTQM0000075886OtherALTIUS
UT005532737OtherMEDICARE ID-TYPE UNSPECIFIED
WY104856200Medicaid
UT37807OtherPEHP
UT1502954OtherUMWA
AZ822107Medicaid
UT53257OtherHEALTHY U
ID804100900Medicaid
UTPRA06691OtherMOLINA
UT87054614NA1OtherEDUCATORS MUTUAL
WY104856200Medicaid