Individual
DR. MARK E FRUIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5444 S. GREEN ST., MURRAY, UT 84123-5632
(801) 262-8120
(801) 262-3897
Mailing address
5444 S. GREEN ST., MURRAY, UT 84123-5632
(801) 262-8120
(801) 262-3897
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
180955-1205
UT
2085R0202X
Diagnostic Radiology Physician
Primary
1809551205
UT
2085R0202X
Diagnostic Radiology Physician
M-11498
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002089673
—
NV
05
—
003698900
—
ID
05
—
004820
—
AZ
05
—
09768
—
UT
05
—
120731800
—
WY
01
—
P00205749
RR MEDICARE
UT
01
—
P00255592
RR MEDICARE
UT
Enumeration date
11/07/2005
Last updated
08/30/2012
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