Provider Demographics
NPI:1184688533
Name:CHRISTIAN, MARK E (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:CHRISTIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5546
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-5546
Mailing Address - Country:US
Mailing Address - Phone:801-397-6200
Mailing Address - Fax:801-397-6200
Practice Address - Street 1:185 S 400 E
Practice Address - Street 2:STE 100
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-4801
Practice Address - Country:US
Practice Address - Phone:801-397-6200
Practice Address - Fax:801-397-6201
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT58481571205207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000092658Medicare PIN
UTPRA02281OtherMOLINA
UT141920853MECOtherEMIA
UT107038791101OtherINTERMOUNTAIN HEALTH CARE
UT86491OtherPEHP
I03310Medicare UPIN
UT005802704Medicare ID - Type Unspecified