# WINSTON N PETERSEN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1194714717
- **Gender:** Man
- **Credential:** PA-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | 262207-1206 | UT | Yes |

## Other

- **Enumeration date:** 10/17/2005
- **Last updated:** 04/29/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000010165444 | REGENCE BLUE SHIELD | ID |
| 01 | — | 000010165445 | REGENCE BLUE SHIELD OF ID | ID |
| 01 | — | 000010165446 | REGENCE BLUE SHIELD OF ID | ID |
| 05 | — | 807969000 | — | ID |
| 05 | — | 807969001 | — | ID |
| 05 | — | 807969002 | — | ID |
| 01 | — | PAG39 | BLUE CROSS OF IDAHO | ID |
| 01 | — | PAG40 | BLUE CROSS OF IDAHO | ID |
| 01 | — | PAG41 | BLUE CROSS OF IDAHO | ID |