MEDICARE: PETER SHUNGEE LIU M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LC0200X	Critical Care Medicine (Anesthesiology) Physician	6606620-1205	UT
2	207L00000X	Anesthesiology Physician	6606620-1205	UT

General Provider Information

NPI Number	:	1124091152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER SHUNGEE LIU M.D.

Provider Business Mailing Address
First Line	:	PO BOX 413034
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84141-3034
Country	:	US
Telephone Number	:	801-581-6393
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 N MEDICAL DR
Second Line	:	U OF U DEPT OF ANESTHESIOLOGY
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84132-0002
Country	:	US
Telephone Number	:	801-581-6393
Fax Number	:	801-581-4367

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2006
Last Update Date	:	11/18/2021

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