Individual
MARK E. HAROUSSEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
30 N 1900 E RM 4C104, SALT LAKE CITY, UT 84132-0002
(801) 585-1686
Mailing address
30 N 1900 E RM 4C104, SALT LAKE CITY, UT 84132-0002
(801) 585-1686
Taxonomy
Speciality
Code
Description
License number
State
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
Primary
10957077-1205
UT
208000000X
Pediatrics Physician
10957077-1205
UT
Other
Enumeration date
03/24/2017
Last updated
11/03/2021
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