Provider Demographics
NPI:1215922919
Name:SCHOW, JAN-ERIK (MD)
Entity type:Individual
Prefix:
First Name:JAN-ERIK
Middle Name:
Last Name:SCHOW
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 1:300 W 1400 S
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84312-9393
Mailing Address - Country:US
Mailing Address - Phone:435-257-2469
Mailing Address - Fax:435-257-2434
Practice Address - Street 1:300 W 1400 S
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:UT
Practice Address - Zip Code:84312-9393
Practice Address - Country:US
Practice Address - Phone:435-257-2469
Practice Address - Fax:435-257-2434
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2892981205207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD1017Medicaid
ID003026600Medicaid
G00930Medicare UPIN
UT080127231Medicare PIN
ID003026600Medicaid