Individual
KEVIN MANGUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
6095 S FASHION BLVD STE 220, MURRAY, UT 84107-7393
(801) 758-8735
(801) 769-2092
Mailing address
6095 S FASHION BLVD STE 220, MURRAY, UT 84107-7393
(801) 758-8735
(801) 769-2092
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
8164477-1204
UT
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
8164477-1204
UT
Other
Enumeration date
03/06/2012
Last updated
06/19/2023
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