Provider Demographics
NPI:1447351978
Name:FEOLA, GIOSUE PETER (MD)
Entity type:Individual
Prefix:DR
First Name:GIOSUE
Middle Name:PETER
Last Name:FEOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:G.
Other - Middle Name:PETER
Other - Last Name:FEOLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:869 E 4500 S
Mailing Address - Street 2:PMB 511
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-3049
Mailing Address - Country:US
Mailing Address - Phone:801-487-0451
Mailing Address - Fax:801-487-2467
Practice Address - Street 1:100 N MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84113-1103
Practice Address - Country:US
Practice Address - Phone:801-662-1900
Practice Address - Fax:801-662-1810
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT347711-12052085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTQM0000027099OtherALTIUS
UT35834OtherDESERT MUTUAL
UT870355724FE1OtherEDUCATORS MUTUAL
UT107008012101OtherSELECTHEALTH
UT1600053OtherUNITED HEALTHCARE
UT2287OtherUUHN
UT47290OtherPUBLIC EMPLOYEES HEALTH
UT8550895OtherAETNA
UT005545507Medicare ID - Type UnspecifiedMEDICARE NUMBER
UT1600053OtherUNITED HEALTHCARE