Healthcare Provider Details

I. General information

NPI: 1689628992
Provider Name (Legal Business Name): GLENN K SCHEMMER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 08/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 NORTH 500 WEST
PROVO UT
84604-3380
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-491-6482
  • Fax:
Mailing address:
  • Phone: 801-491-6482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4952066-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number4952066-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: