Healthcare Provider Details

I. General information

NPI: 1124091152
Provider Name (Legal Business Name): PETER SHUNGEE LIU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N MEDICAL DR U OF U DEPT OF ANESTHESIOLOGY
SALT LAKE CITY UT
84132-0002
US

IV. Provider business mailing address

PO BOX 413034
SALT LAKE CITY UT
84141-3034
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-6393
  • Fax: 801-581-4367
Mailing address:
  • Phone: 801-581-6393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number6606620-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number6606620-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: