Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 4985237-1205 | UT |
NPI | 1013008077 |
---|---|
Provider Name | Matthew L Peterson |
First Address | Salt Lake City, UT 84121-6800 |
Second Address | Salt Lake City, UT 84124-1300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000009351150 | PHCS (01) | UT |
107037417102 | IHC (01) | UT |
236437 | ALTIUS (01) | UT |
38892 | HEALTHY U (01) | UT |
7710087 | CIGNA (01) | UT |
83147 | PEHP (01) | UT |
878277 | DESERET MUTUAL (01) | UT |
I17694 | (02) | UT |
TPRA1129 | MOLINA (01) | UT |