MEDICARE: DR. DOUGLAS SCHOW JR. M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	1555561205	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2440	OTHER	UT	PEHP
2	PRA02825	OTHER	UT	MOLINA HEALTHCARE
3	QM0000026748	OTHER	UT	ALTIUS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	107006255101	OTHER		INTERMOUNTAIN HEALTHCARE
6	156217CU	OTHER	NY	PREFERRED CARE
7	35924	OTHER	UT	DMBA
8	870363636SC1	OTHER	UT	EMIA
9	0118504	OTHER	WA	LABOR AND INDUSTRIES
10	0991803	OTHER	UT	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1811995004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS SCHOW JR. M.D.

Provider Business Mailing Address
First Line	:	1055 N 300 W
Second Line	:	STE 203
City	:	PROVO
State	:	UT
Zip	:	84604-3374
Country	:	US
Telephone Number	:	801-374-9053
Fax Number	:	801-357-7869

Provider Business Practice Location Address
First Line	:	1055 N 300 W
Second Line	:	STE 203
City	:	PROVO
State	:	UT
Zip	:	84604-3344
Country	:	US
Telephone Number	:	801-374-9053
Fax Number	:	801-357-7869

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	04/09/2008

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