Provider Demographics
NPI:1811995004
Name:SCHOW, DOUGLAS JR (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
Last Name:SCHOW
Suffix:JR
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 1:1055 N 300 W
Mailing Address - Street 2:STE 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:STE 203
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3344
Practice Address - Country:US
Practice Address - Phone:801-374-9053
Practice Address - Fax:801-357-7869
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1555561205207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT2440OtherPEHP
UTPRA02825OtherMOLINA HEALTHCARE
UTQM0000026748OtherALTIUS
AKMD374UTMedicaid
107006255101OtherINTERMOUNTAIN HEALTHCARE
NY156217CUOtherPREFERRED CARE
UT35924OtherDMBA
UT870363636SC1OtherEMIA
WA0118504OtherLABOR AND INDUSTRIES
UT0991803OtherUNITED HEALTHCARE
D20417Medicare UPIN
UT0799430001Medicare NSC