Individual
MARK C SANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1184 E 80 N, AMERICAN FORK, UT 84003-2906
(801) 763-3885
(801) 763-3887
Mailing address
1055 N 500 W, CREDENTIALING DEPARTMENT, PROVO, UT 84604-3305
(801) 354-8225
(801) 418-0941
Taxonomy
Speciality
Code
Description
License number
State
207XS0106X
Orthopaedic Hand Surgery Physician
187115-1205
UT
2082S0105X
Surgery of the Hand (Plastic Surgery) Physician
187115-1205
UT
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
187115-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107005288103
IHC
UT
01
—
13-00081
UNITED HEALTHCARE
UT
01
—
215832
ALTIUS
UT
01
—
54270
DMBA
UT
01
—
79371
PEHP
UT
05
—
870281028000
—
UT
01
—
870281028SAN
EMIA
UT
01
—
P00167990
PALMETTO
UT
Enumeration date
09/27/2006
Last updated
11/27/2023
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