Healthcare Provider Details

I. General information

NPI: 1952941106
Provider Name (Legal Business Name): MARC STEFFEN SCHMITZ-VALCKENBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2020
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 S MARIO CAPECCHI DR
SALT LAKE CITY UT
84132-0005
US

IV. Provider business mailing address

65 S MARIO CAPECCHI DR
SALT LAKE CITY UT
84132-0005
US

V. Phone/Fax

Practice location:
  • Phone: 801-213-2424
  • Fax: 801-581-4085
Mailing address:
  • Phone: 801-213-2424
  • Fax: 801-581-4085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number11318011-1251
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number11318011-1251
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: