Individual
MARK DALE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6321 S REDWOOD RD, SUITE 201, SALT LAKE CITY, UT 84123-6798
(801) 265-2212
(801) 265-0103
Mailing address
PO BOX 35380, LAS VEGAS, NV 89133-5380
(801) 265-2212
(801) 265-0103
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
182573-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
529190498001
—
UT
Enumeration date
06/15/2006
Last updated
06/21/2021
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