Mark Montogomery Sullivan, PAC, MPAS

NPI #1700023348 in Murray, Utah

Provider Information

NPI Number: 1700023348
Entity Type: Individual
Name: Mark Montogomery Sullivan, PAC, MPAS
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physician Assistant
Credential: PAC, MPAS
Enumeration Date: Jan 20, 2009
Last Updated: Jan 25, 2010

Practice Location

Address: 5121 COTTONWOOD ST
Address 2: SUITE 320
City: Murray
State: Utah
ZIP Code: 84107-5701
Phone: (801) 507-3380

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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