Healthcare Provider Details

I. General information

NPI: 1891908216
Provider Name (Legal Business Name): ANDY P PEIFFER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 10/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 G ST
SALT LAKE CITY UT
84103-3244
US

IV. Provider business mailing address

633 G. ST.
SALT LAKE CITY UT
84103
US

V. Phone/Fax

Practice location:
  • Phone: 801-521-2102
  • Fax: 801-521-2830
Mailing address:
  • Phone: 801-580-8855
  • Fax: 801-521-2830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number274489-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: