Healthcare Provider Details

I. General information

NPI: 1215922919
Provider Name (Legal Business Name): JAN-ERIK SCHOW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W 1400 S
GARLAND UT
84312-9393
US

IV. Provider business mailing address

300 W 1400 S
GARLAND UT
84312-9393
US

V. Phone/Fax

Practice location:
  • Phone: 435-257-2469
  • Fax: 435-257-2434
Mailing address:
  • Phone: 435-257-2469
  • Fax: 435-257-2434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number2892981205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: