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Individual

MARK STEFFENSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1034 N 500 W, PROVO, UT 84604-3380
(801) 993-9582
(801) 733-5618
Mailing address
2975 EXECUTIVE PKWY, 200, LEHI, UT 84043-9642
(801) 990-1911
(801) 990-1912

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
87-177636-1205
UT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0020878700
NV
05
09071
UT
01
107006556101
IHC
UT
05
119682100
WY
01
18414
DMBA
UT
01
2090168 20-00312
UHC
UT
01
37822
PEHP
UT
05
804273100
ID
05
825169
AZ
01
870545614 84121 A029
TRICARE
UT
01
870545614ST2
EDUCATORS MUTUAL
UT
01
PRA01907
MOLINA
UT
Enumeration date
09/22/2006
Last updated
07/17/2009
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