Healthcare Provider Details

I. General information

NPI: 1144229931
Provider Name (Legal Business Name): PETER KENNETH MOSKOWITZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 11/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6360 S 3000 E STE 230
COTTONWOOD HEIGHTS UT
84121-6923
US

IV. Provider business mailing address

7929 S FOREST OAKS CT
COTTONWOOD HEIGHTS UT
84121-5737
US

V. Phone/Fax

Practice location:
  • Phone: 801-523-3030
  • Fax: 801-523-3033
Mailing address:
  • Phone: 801-274-0317
  • Fax: 801-210-5350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number3471031205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: