Ebert, Mark Douglas
Ebert, Mark Douglas is an individual health care provider with primary practice located at 100 N Mario Capecchi Dr Dept Of Medical Imaging, Salt Lake City UT 84113-1103. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatric Radiology, which is considered as his primary health care specialty. Ebert, Mark Douglas can be contacted via phone (801) 875-1586.Contact Information
Primary practice address
100 N Mario Capecchi Dr Dept Of Medical Imaging
Salt Lake City UT 84113-1103
Phone: (801) 875-1586
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatric Radiology | 2085P0229X | M-11694 | Idaho |
| Allopathic & Osteopathic Physicians / Pediatric Radiology | 2085P0229X | MED-PHYS-LIC-52597 | Montana |
| Allopathic & Osteopathic Physicians / Pediatric Radiology | 2085P0229X | 8209945-1205 | Utah |
Profile Details
| NPI number | 1609901610 |
|---|---|
| LBN Legal business name | Ebert, Mark Douglas |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 22nd, 2007 |
| Last updated | Aug 23rd, 2023 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1609901610 | NPPES |
| Pennsylvania | Other | MT188031 | STATE LICENSE NUMBER |
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