Mark Allen Fullmer, M.D.

Surgery Physician · Provo, UT

Individual Active NPI

NPI number 1457420853

Practice location

1055 N 300 W
Suite 418
Provo, UT 84604-3344
Phone
(801) 357-7100
Fax
(801) 357-8100

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NPI record

NPI
1457420853
Entity type
Individual (Type 1)
Enumeration date
November 7, 2006
Last updated
March 7, 2023
Certified
May 16, 2021
Sole proprietor
Yes

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Surgery Physician Primary 208600000X 152450-1205 UT

Mailing address

1512 Renaissance Towne Dr Ste 200
Bountiful, UT 84010-7517
Phone
(385) 204-2722
Fax
(801) 734-3898

About Dr. Fullmer

Mark Allen Fullmer, M.D. is a healthcare provider registered in the NPI registry with the primary taxonomy Surgery Physician (code 208600000X). The practice location is 1055 N 300 W, Suite 418, Provo, UT 84604-3344. The NPI number 1457420853 was assigned on November 7, 2006 and the record was last updated on March 7, 2023.

Dr. Fullmer lists a license in the registry: #152450-1205 (UT) for Surgery Physician. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Mark Allen Fullmer, M.D.?

The NPI number is 1457420853.

What is the phone number of Dr. Fullmer?

The phone number listed for the practice location is (801) 357-7100.

Where is Dr. Fullmer located?

1055 N 300 W, Suite 418, Provo, UT 84604-3344.

What is the taxonomy code for Dr. Fullmer?

The primary taxonomy code is 208600000X – Surgery Physician.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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