Provider Demographics
NPI:1922065598
Name:TIPTON, MARY D (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:D
Last Name:TIPTON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3584 W 9000 S STE 404
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-5712
Mailing Address - Country:US
Mailing Address - Phone:801-890-3837
Mailing Address - Fax:801-743-7596
Practice Address - Street 1:3570 W 9000 S STE 220
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-8873
Practice Address - Country:US
Practice Address - Phone:801-890-3837
Practice Address - Fax:801-743-7596
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2025-06-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT5934303-1205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005596706Medicare PIN
UTI28288Medicare UPIN