Provider Demographics
NPI:1336148063
Name:SCHWARTZ, RICHARD H (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:H
Last Name:SCHWARTZ
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 1:1220 E 3900 S
Mailing Address - Street 2:STE 4-E
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1327
Mailing Address - Country:US
Mailing Address - Phone:801-261-8507
Mailing Address - Fax:801-261-8511
Practice Address - Street 1:1220 E 3900 S
Practice Address - Street 2:STE 4-E
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1327
Practice Address - Country:US
Practice Address - Phone:801-261-8507
Practice Address - Fax:801-261-8511
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT180567-1205207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTC91584Medicare UPIN