DR. MARK DOUGLAS EBERT (NPI# 1609901610) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609901610 |
| Entity Type | Individual |
| Full Name | DR. MARK DOUGLAS EBERT |
| Credential | MD |
| Practice Address |
5444 S. Green St. Murray UT 84123-5632 |
| Mailing Address |
100 N Mario Capecchi Dr Dept of Medical Imaging Salt Lake City UT 84113-1103 |
| Practice Telephone | 8012628120 |
| Practice Fax Number | 8012625721 |
| Mailing Telephone | 8018751586 |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2020-07-31 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2085P0229X |
Radiology Specialization: Pediatric Radiology |
MED-PHYS-LIC-525 | MT | Allopathic & Osteopathic Physicians |
| N | 2085P0229X |
Radiology Specialization: Pediatric Radiology |
M-11694 | ID | Allopathic & Osteopathic Physicians |
| Y | 2085P0229X |
Radiology Specialization: Pediatric Radiology |
8209945-1205 | UT | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PA | STATE LICENSE NUMBER | MT188031 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801882097 | Mark Oren Ebert | Obstetrics & Gynecology | 3300 Nw Expressway, Oklahoma City, OK 73112-4418 | 2005-09-22 |
| Street Address |
5444 S. GREEN ST. |
| City | MURRAY |
| State | UT |
| Zip Code | 84123-5632 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275530289 | W Robert Brinton | Radiology | 5444 S. Green St., Murray, UT 84123-5632 | 2005-07-05 |
| 1841449030 | Daniel Newel Johnson | Radiology | 5444 S. Green St., Murray, UT 84123-5632 | 2008-09-12 |
| 1033367065 | Jonathan Scott Shakespear | Radiology | 5444 S. Green St., Murray, UT 84123-5632 | 2008-09-03 |
| 1518128552 | Logan Arron Mclean | Radiology | 5444 S. Green St., Murray, UT 84123-5632 | 2008-06-23 |
| 1689860850 | Benjamin Hollis James Gordon | Radiology | 5444 S. Green St., Murray, UT 84123-5632 | 2007-09-20 |
| 1497953384 | David S Francom | Radiology | 5444 S. Green St., Murray, UT 84123-5632 | 2007-07-03 |
| 1215058011 | Matthew Guyon Whitten | Surgery | 5444 S. Green St., Murray, UT 84123-5632 | 2007-04-02 |
| 1508905514 | Fernando Rodriguez | Radiology | 5444 S. Green St., Murray, UT 84123-5632 | 2007-02-06 |
| 1306997630 | Christopher S Olson | Nurse Practitioner | 5444 S. Green St., Murray, UT 84123-5632 | 2007-01-15 |
| 1215977491 | Brett T Parkinson | Radiology | 5444 S. Green St., Murray, UT 84123-5632 | 2006-06-07 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679186837 | Utah Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 5792 South Redwood Road, Taylorsville, UT 84123 | 2020-08-27 |
| 1164040614 | Mark E Hutchinson | Counselor | 5047 S Galleria Drive, Murray, UT 84123 | 2020-07-10 |
| 1396259321 | Utah Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 4082 South Redwood Road, West Valley Road, UT 84123 | 2017-11-29 |
| 1083131890 | Kelli Mcstotts | Counselor | 5689 S. Redwood Road, Taylorsville, UT 84123 | 2017-08-23 |
| 1740706571 | Laura B Ellsworth | Case Manager/Care Coordinator | 5667 So. Redwood Road, 6b, Salt Lake City, UT 84123 | 2017-08-14 |
| 1790214120 | Integrated Autism Therapies | Behavioral Analyst | 5984 S. Susquehanna, Murray, UT 84123 | 2017-06-08 |
| 1083163885 | Michael John Flint | Counselor | 5861 South Redwood Road, #24, Taylorsville, UT 84123 | 2016-09-22 |
| 1548716236 | Andres Ramos | Licensed Psychiatric Technician | 697 West 4170 South, Murray, UT 84123 | 2016-09-01 |
| 1467807040 | Sheryl R Schindler | Counselor | 5770 South 1550 West, Bldg G, Primary Children's Counseling Center, Taylorsville, UT 84123 | 2016-05-02 |
| 1730562141 | Megan Merica Snarr | Dentist | 597 West 5300 South, Murray, UT 84123 | 2015-07-02 |
| Find all providers in zip 84123 | ||||
| Taxonomy Code | 2085P0229X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Pediatric Radiology |
| A radiologist who is proficient in all forms of diagnostic imaging as it pertains to the treatment of diseases in the newborn, infant, child and adolescent. This specialist has knowledge of both imaging and interventional procedures related to the care and management of diseases of children. A pediatric radiologist must be highly knowledgeable of all organ systems as they relate to growth and development, congenital malformations, diseases peculiar to infants and children and diseases that begin in childhood but cause substantial residual impairment in adulthood. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407182835 | Orthoppedic Practice Associates | Radiology | 3773 W 126000 S, Riverton, UT 84065-1234 | 2009-10-20 |
| 1720198716 | William D. Winters | Radiology | 100 No Mario Capecchi Dr., Salt Lake City, UT 84113 | 2006-08-30 |
| 1215940465 | Karin L. Hoeg | Radiology | 100 No. Mario Capecchi Dr., Salt Lake City, UT 84113 | 2006-08-15 |
| 1811940166 | Joshua Q Knowlton | Radiology | 560 W 800 N, Orem, UT 84057-3746 | 2006-05-18 |
| 1053664680 | Ihc Health Services Inc | Radiology | 100 Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2012-10-19 |
| 1730394131 | Ryan W. Arnold | Radiology | 100 Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2007-05-11 |
| 1083739270 | Henry J Baskin Jr. | Radiology | 100 Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2007-03-20 |
| 1790875300 | Kathleen Ann Murray | Radiology | Fairfax Road At Virginia Street, Shriners Hosptials for Children, Salt Lake City, UT 84103-4399 | 2006-10-13 |
| 1447351978 | Giosue Peter Feola | Radiology | 100 N Medical Dr, Salt Lake City, UT 84113-1103 | 2006-09-26 |
| 1063513596 | Constance K Maves | Radiology | 100 N Medical Dr, Salt Lake City, UT 84113-1103 | 2006-09-26 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.