Active NPI
Stephen Proskauer, M.D.
- Psychiatry Physician
- Salt Lake City, UT
National Provider Identifier
1871769711
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 5029959-1205
- Practice address
- 860 E 4500 S
Suite 302
Salt Lake City, UT 84107-3002 - Phone
- (801) 631-8426
- Fax
- (801) 268-3777
- NPI assigned
- May 1, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 5029959-1205 | UT | Primary |
| Child & Adolescent Psychiatry Physician | 2084P0804X | 5029959-1205 | UT |
Addresses
Primary practice location
860 E 4500 S
Suite 302
Salt Lake City, UT 84107-3002
Mailing address
860 E 4500 S
Suite 302
Salt Lake City, UT 84107-3002
Phone (801) 631-8426
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5029959-1205 | UT | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1209600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209600000000",
"number": "1871769711",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "860 E 4500 S",
"address_2": "SUITE 302",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841073002",
"telephone_number": "801-631-8426",
"fax_number": "801-268-3777"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "860 E 4500 S",
"address_2": "SUITE 302",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841073002",
"telephone_number": "801-631-8426",
"fax_number": "801-268-3777"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROSKAUER",
"first_name": "STEPHEN",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-05-01",
"last_updated": "2008-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "UT",
"license": "5029959-1205",
"primary": true
},
{
"code": "2084P0804X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
"state": "UT",
"license": "5029959-1205",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.