Individual
MARK MONTOGOMERY SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC, MPAS
Contact information
Practice address
5121 COTTONWOOD ST, SUITE 320, MURRAY, UT 84107-5701
(801) 507-3380
Mailing address
2609 OAK CREEK DR, SANDY, UT 84093-6522
(801) 244-2834
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
7131889-1206
UT
Other
Enumeration date
01/20/2009
Last updated
01/25/2010
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