MEDICARE: PETER J. EDMONDS MD

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	207R00000X	Internal Medicine Physician	58540	TN
2	207RS0012X	Sleep Medicine (Internal Medicine) Physician	13327654-1205	UT
3	207RP1001X	Pulmonary Disease Physician	13327654-1205	UT

General Provider Information

NPI Number	:	1417301334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER J. EDMONDS MD

Provider Business Mailing Address
First Line	:	PO BOX 27128
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84127-0128
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	324 E 10TH AVE STE 170
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84103-2858
Country	:	US
Telephone Number	:	801-408-6131
Fax Number	:

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

Provider Enumeration Date	:	04/18/2016
Last Update Date	:	11/17/2025

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