Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 2892981205 | UT |
NPI | 1215922919 |
---|---|
Provider Name | Jan-Erik Schow |
First Address | Garland, UT 84312-9393 |
Second Address | Garland, UT 84312-9393 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2005 |
Last Update Date | 28/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003026600 | (05) | ID |
D1017 | (05) | UT |
G00930 | (02) |