Individual
MARY P BRONNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
500 CHIPETA, ARUP LABORATORIES, SALT LAKE CITY, UT 84108
(801) 583-2787
(801) 581-0735
Mailing address
500 CHIPETA, ARUP LABORATORIES, SALT LAKE CITY, UT 84108
(801) 583-2787
(801) 581-0735
Taxonomy
Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
35083002B
OH
207ZP0101X
Anatomic Pathology Physician
Primary
7817974-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2449872
—
OH
01
—
P00907176
RAILROAD MEDICARE
—
Enumeration date
04/19/2006
Last updated
12/03/2021
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