Active NPI
Mark D Kirkham, MD
- Family Medicine Physician
- Layton, UT
National Provider Identifier
1689650459
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 1873711205
- Practice address
- 2121 N 1700 W
Layton, UT 84041-8803 - Phone
- (801) 773-4840
- Fax
- (801) 525-8187
- NPI assigned
- Dec 22, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 1873711205 | UT | Primary |
Addresses
Primary practice location
2121 N 1700 W
Layton, UT 84041-8803
Mailing address
PO Box 337
Layton, UT 84041-0337
Phone (801) 773-4840
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 005701328 | Medicaid | UT | |
| 11072 | Medicaid | UT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1873711205 | UT | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135209600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1343865600000",
"number": "1689650459",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 337",
"city": "LAYTON",
"state": "UT",
"postal_code": "840410337",
"telephone_number": "801-773-4840",
"fax_number": "801-525-8187"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2121 N 1700 W",
"city": "LAYTON",
"state": "UT",
"postal_code": "840418803",
"telephone_number": "801-773-4840",
"fax_number": "801-525-8187"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIRKHAM",
"first_name": "MARK",
"middle_name": "D",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-22",
"last_updated": "2012-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "UT",
"license": "1873711205",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "005701328",
"state": "UT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "11072",
"state": "UT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Layton, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.