Dr. Mark William Peterson
Family Doctor Family Doctor - Sports Medicine
2200 Park Ave. Bldg. D Ste. 100
Park City
, Utah 84060
Dr. Mark William Peterson
Family Doctor Family Doctor - Sports Medicine
2200 Park Ave. Bldg. D Ste. 100
Park City
, Utah 84060
(479) 795-0426
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About
Features
Specialties
- Family Doctor
- Family Doctor - Sports Medicine
Languages spoken
- English
Location
First Address
- Dr. Mark William Peterson
- 101 Sun Meadow Dr
- Centerton, AR
- Zip : 72719-9610
- Phone : (479) 795-0426
Second Address
- Dr. Mark William Peterson
- 2200 Park Ave. Bldg. D Ste. 100
- Park City, UT
- Zip : 84060
- Fax : (435) 615-8823
- Phone : (435) 615-8822
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 207Q00000X | Family Doctor | 5101018542 | MI |
| N | 207Q00000X | Family Doctor | E7679 | AR |
| Y | 207QS0010X | Family Doctor - Sports Medicine | 8743560-1204 | UT |
National Provider Identifier
| NPI | 1326374562 |
|---|---|
| Provider Name | Dr. Mark William Peterson |
| First Address | Centerton, AR 72719-9610 |
| Second Address | Park City, UT 84060 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 22/10/2009 |
| Last Update Date | 18/02/2020 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.