Individual
DR. MARK ALLEN FULLMER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1055 N 300 W, SUITE 418, PROVO, UT 84604-3344
(801) 357-7100
(801) 357-8100
Mailing address
1512 RENAISSANCE TOWNE DR STE 200, BOUNTIFUL, UT 84010-7517
(385) 204-2722
(801) 734-3898
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
152450-1205
UT
Other
Enumeration date
11/07/2006
Last updated
03/07/2023
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