Provider Demographics
NPI:1437347770
Name:SUMMIT LASER MEDICAL ARTS, LLC
Entity Type:Organization
Organization Name:SUMMIT LASER MEDICAL ARTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:FEUER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-414-5339
Mailing Address - Street 1:2952 CAITLAND CT
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-7018
Mailing Address - Country:US
Mailing Address - Phone:801-414-5339
Mailing Address - Fax:
Practice Address - Street 1:2952 CAITLAND CT
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-7018
Practice Address - Country:US
Practice Address - Phone:801-414-5339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5252145-12052086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD4937Medicaid
UTD4937Medicaid