Individual
JOHN MARK RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8TH AVE AND C ST, SALT LAKE CITY, UT 84143-4610
(801) 507-4384
(801) 507-4398
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
13939802-1205
UT
208M00000X
Hospitalist Physician
Primary
13939802-1205
UT
Other
Enumeration date
05/11/2021
Last updated
09/18/2024
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