Organization
M D CORGIAT PA
Active
Other names
Mark D. Corgiat, Ph.D.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK DAVID CORGIAT PH.D. (OWNER,DIRECTOR)
(801) 621-6100
Entity
Organization
Contact information
Practice address
3903 HARRISON BLVD, SUITE 305, OGDEN, UT 84403-2314
(801) 387-3807
(801) 387-3810
Mailing address
3903 HARRISON BLVD, SUITE 305, OGDEN, UT 84403-2314
(801) 387-3807
(801) 387-3810
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6344743-2501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1336296003
PERSONAL NPI
UT
05
—
1336296003
—
UT
Enumeration date
02/21/2008
Last updated
09/03/2010
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