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Organization
BRIDGE UTAH MEDICAL GROUP
Active
Organization
BRIDGE UTAH MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAMERON G PETERSON MD (CHIEF MEDICAL OFFICER, MANAGING PAR)
(801) 598-8337
Entity
Organization
Contact information
Practice address
1015 E 100 N, LOGAN, UT 84321-4873
(888) 221-0423
(888) 221-9816
Mailing address
PO BOX 1468, BOUNTIFUL, UT 84011-1468
(888) 853-8973
(888) 959-9385
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
NULL
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
Other
Enumeration date
01/26/2018
Last updated
03/14/2019
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