Healthcare Provider Details

I. General information

NPI: 1003042375
Provider Name (Legal Business Name): ERIC SCHENFELD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2009
Last Update Date: 08/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5171 COTTONWOOD ST SUITE 740
MURRAY UT
84107-5704
US

IV. Provider business mailing address

5171 COTTONWOOD ST SUITE 740
MURRAY UT
84107-5704
US

V. Phone/Fax

Practice location:
  • Phone: 801-507-9700
  • Fax: 801-507-9705
Mailing address:
  • Phone: 801-507-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number156598
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number8280012-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: