# SHANE L PETERSEN

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

## Provider details

- **NPI number:** 1770593246
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | 2434068-1205 | UT | Yes |
| 207L00000X | Anesthesiology Physician | MD227949 | OR | — |

## Other

- **Enumeration date:** 08/08/2006
- **Last updated:** 12/29/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100506343 | — | NV |
| 01 | — | 107038030101 | IHC | UT |
| 05 | — | 121124200 | — | WY |
| 01 | — | 1502954 | UMWA | UT |
| 01 | — | 2090168 | UNITED HEALTHCARE | UT |
| 01 | — | 24340681200001 | REGENCE BCBS | UT |
| 05 | — | 807171600 | — | ID |
| 01 | — | 83770 | PEHP | UT |
| 01 | — | 907869 | DESERET MUTUAL | UT |
| 05 | — | 941379 | — | AZ |
| 01 | — | 99469 | HEALTHY U | UT |
| 01 | — | QM0000075886 | ALTIUS | UT |
| 01 | — | QMP000003262280 | MOLINA | UT |