Healthcare Provider Details

I. General information

NPI: 1447351978
Provider Name (Legal Business Name): GIOSUE PETER FEOLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: G. PETER FEOLA MD

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N MEDICAL DR
SALT LAKE CITY UT
84113-1103
US

IV. Provider business mailing address

869 E 4500 S PMB 511
SALT LAKE CITY UT
84107-3049
US

V. Phone/Fax

Practice location:
  • Phone: 801-662-1900
  • Fax: 801-662-1810
Mailing address:
  • Phone: 801-487-0451
  • Fax: 801-487-2467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberDR.0075917
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number347711-1205
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberDR.0075917
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberDR.0075917
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberDR.0075917
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: