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Organization
UNIVERSITY OF UTAH OB DIAGNOSTIC CENTER
Active
Organization
UNIVERSITY OF UTAH OB DIAGNOSTIC CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
C. MATTHEW PETERSON MD (DEPARTMENT CHAIR)
(801) 581-2719
Entity
Organization
Contact information
Practice address
50 N MEDICAL DR, SALT LAKE CITY, UT 84132-0001
(801) 581-2719
Mailing address
PO BOX 58859, SALT LAKE CITY, UT 84158-0859
(801) 585-5172
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
2085U0001X
Diagnostic Ultrasound Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003054800
IDAHO MEDICAID
ID
01
—
100503089
NEVADA MEDICAID
NV
01
—
117769900
WYOMING MEDICAID
WY
05
—
870410144009
—
UT
Enumeration date
06/25/2006
Last updated
06/30/2008
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