Healthcare Provider Details

I. General information

NPI: 1669507562
Provider Name (Legal Business Name): DOUGLAS SCHOW JR., M.D. A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 N 300 W SUITE 203
PROVO UT
84604-3374
US

IV. Provider business mailing address

1055 N 300 W SUITE 203
PROVO UT
84604-3374
US

V. Phone/Fax

Practice location:
  • Phone: 801-374-9053
  • Fax: 801-357-7869
Mailing address:
  • Phone: 801-374-9053
  • Fax: 801-357-7869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number155556-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number155556-1205
License Number StateUT

VIII. Authorized Official

Name: DR. DOUGLAS SCHOW JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 801-374-9053