Provider Demographics
NPI:1194824961
Name:NEUMAN, MARK DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:DAVID
Last Name:NEUMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1208 E 3300 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-2522
Mailing Address - Country:US
Mailing Address - Phone:801-483-1600
Mailing Address - Fax:801-483-1610
Practice Address - Street 1:1208 E 3300 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-2522
Practice Address - Country:US
Practice Address - Phone:801-483-1600
Practice Address - Fax:801-483-1610
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT4749999-12052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005810501Medicare ID - Type Unspecified
UTI46940Medicare UPIN