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Organization
J. DAYNE PETERSEN M.D., PC
Active
Organization
J. DAYNE PETERSEN M.D., PC
Active
Other names
NuVista Plastic Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON DAYNE PETERSEN M.D. (PRESIDENT)
(801) 971-8684
Entity
Organization
Contact information
Practice address
5353 S 960 E, #150, SALT LAKE CITY, UT 84117-3569
(801) 261-5791
(801) 747-7740
Mailing address
5353 S 960 E, #150, SALT LAKE CITY, UT 84117-3569
(801) 261-5791
(801) 747-7740
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
83185641205
UT
Other
Enumeration date
08/07/2012
Last updated
08/30/2012
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