Provider Demographics
NPI:1972760106
Name:SCHMIDT, JOHN DAVID (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9829 S 1300 E
Mailing Address - Street 2:SUITE 300 GRANITE PEAKS GASTROENTEROLOGY
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094
Mailing Address - Country:US
Mailing Address - Phone:801-619-9000
Mailing Address - Fax:801-619-9001
Practice Address - Street 1:9829 S 1300 E
Practice Address - Street 2:SUITE 300 GRANITE PEAKS GASTROENTEROLOGY
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094
Practice Address - Country:US
Practice Address - Phone:801-619-9000
Practice Address - Fax:801-619-9001
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT68990971205207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology