Healthcare Provider Details

I. General information

NPI: 1972760106
Provider Name (Legal Business Name): JOHN DAVID SCHMIDT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 01/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9829 S 1300 E SUITE 300 GRANITE PEAKS GASTROENTEROLOGY
SANDY UT
84094
US

IV. Provider business mailing address

9829 S 1300 E SUITE 300 GRANITE PEAKS GASTROENTEROLOGY
SANDY UT
84094
US

V. Phone/Fax

Practice location:
  • Phone: 801-619-9000
  • Fax: 801-619-9001
Mailing address:
  • Phone: 801-619-9000
  • Fax: 801-619-9001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number68990971205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: