Provider Demographics
NPI:1245297688
Name:MORITZ, MARK E (DPM)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:MORITZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 404
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-0404
Mailing Address - Country:US
Mailing Address - Phone:801-269-9939
Mailing Address - Fax:801-405-7695
Practice Address - Street 1:1220 E 3900 S STE 4D
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1383
Practice Address - Country:US
Practice Address - Phone:801-269-9939
Practice Address - Fax:801-269-9949
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT326708-8907213ES0103X
UT326708-0501213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT91549704030Medicaid
UT005737702Medicare PIN
U69392Medicare UPIN