Individual
MARK W RALLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1200 E 3900 S, SALT LAKE CITY, UT 84124-1300
(801) 268-7288
Mailing address
1954 FORT UNION BLVD, SALT LAKE CITY, UT 84121-6800
(801) 993-9512
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
180903-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09750
—
UT
Enumeration date
07/13/2005
Last updated
08/28/2007
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