Healthcare Provider Details

I. General information

NPI: 1508806233
Provider Name (Legal Business Name): PETER SCHLOESSER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 01/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5444 GREEN ST
MURRAY UT
84123-5632
US

IV. Provider business mailing address

5444 GREEN ST
MURRAY UT
84123-5632
US

V. Phone/Fax

Practice location:
  • Phone: 801-262-8120
  • Fax: 801-262-8120
Mailing address:
  • Phone: 801-262-2647
  • Fax: 801-262-3897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number371396-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number371396-1205
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberM-10604
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: