Individual
DR. MARK W. REILLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1050 E SOUTH TEMPLE, SALT LAKE CITY, UT 84102-1507
(801) 350-8400
(801) 350-4021
Mailing address
24 S 1100 E, SUITE #306, SALT LAKE CITY, UT 84102-1500
(801) 359-8956
(801) 355-5250
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
10960
MT
2085R0001X
Radiation Oncology Physician
12470A
WY
2085R0001X
Radiation Oncology Physician
Primary
187816-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000092076
BLUE CROSS BLUE SHIELD MT
MT
05
—
1699799981
—
MT
Enumeration date
07/27/2006
Last updated
11/12/2024
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