Provider Demographics
NPI:1962453688
Name:DEVENPORT, MARK JONATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JONATHAN
Last Name:DEVENPORT
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1055 N 500 W
Mailing Address - Street 2:ATT. CREDENTIALING
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604
Mailing Address - Country:US
Mailing Address - Phone:801-354-8225
Mailing Address - Fax:801-418-0941
Practice Address - Street 1:672 W. 400 S.
Practice Address - Street 2:SUITE 101
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663
Practice Address - Country:US
Practice Address - Phone:801-491-9883
Practice Address - Fax:801-489-3141
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2023-10-11
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Provider Licenses
StateLicense IDTaxonomies
UT340404-1205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics