Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. Mark Allen Fullmer, MD

Individual provider Surgery Physician · NPI 1457420853

Dr. Mark Allen Fullmer, MD is a Surgery Physician in Provo, Utah. Practices as a sole proprietor. Licensed in Utah.

Licensed in
UT
In the registry since
2006
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

1055 N 300 W Ste 418
Provo, UT 84604-3344
Phone: (801) 357-7100
Fax: (801) 357-8100
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgery Physician (primary) Taxonomy 208600000X · Licence 152450-1205 (UT)

Record details

NPI number1457420853
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorYes
NPI enumeratedNovember 7, 2006
Last updated in NPPESMarch 7, 2023
Certification dateMay 16, 2021
Mailing address1512 Renaissance Towne Dr Ste 200, Bountiful, UT 84010-7517

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