Provider Demographics
NPI:1669507562
Name:DOUGLAS SCHOW JR., M.D. A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DOUGLAS SCHOW JR., M.D. A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHOW
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:801-374-9053
Mailing Address - Street 1:1055 N 300 W
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3374
Mailing Address - Country:US
Mailing Address - Phone:801-374-9053
Mailing Address - Fax:801-357-7869
Practice Address - Street 1:1055 N 300 W
Practice Address - Street 2:SUITE 203
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3374
Practice Address - Country:US
Practice Address - Phone:801-374-9053
Practice Address - Fax:801-357-7869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT155556-1205207X00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT519542457009Medicaid
UT0799430001Medicare NSC