Individual
MARK WILSON THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1034 N 500 W, PROVO, UT 84604
(208) 360-3560
Mailing address
334 W 800 S, SALEM, UT 84653-5611
(208) 360-3560
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
02004574A
IN
207L00000X
Anesthesiology Physician
Primary
12106328-1204
UT
207L00000X
Anesthesiology Physician
DO222639
OR
207L00000X
Anesthesiology Physician
MED-PHYS-LIC-47547
MT
Other
Enumeration date
05/25/2012
Last updated
01/16/2025
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