Individual
MARY GRETCHEN MOOERS
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
324 TENTH AVE, SUITE # 160, SALT LAKE CITY, UT 84103-2853
(801) 408-5151
(801) 408-3598
Mailing address
324 TENTH AVE, SUITE # 160, SALT LAKE CITY, UT 84103-2853
(801) 408-5151
(801) 408-3598
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
173770-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00558
IHC
UT
05
—
2099000
—
UT
01
—
224999
ALTIUS PROVIDER #
UT
01
—
274
TRICARE #
UT
01
—
2748
DESERET MUTUAL
UT
01
—
357645
MOLINA #
UT
01
—
71116
PEHP #
UT
01
—
870623071M01
EDUCATORS MUTUAL #
UT
01
—
9200054
UHC
UT
Enumeration date
05/31/2006
Last updated
07/09/2007
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