Individual
MARK D KIRKHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2121 N 1700 W, LAYTON, UT 84041-8803
(801) 773-4840
(801) 525-8187
Mailing address
PO BOX 337, LAYTON, UT 84041-0337
(801) 773-4840
(801) 525-8187
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1873711205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005701328
—
UT
05
—
11072
—
UT
Enumeration date
12/22/2005
Last updated
08/02/2012
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