Individual
TRAVIS A PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1055 N 500 W STE 207, PROVO, UT 84604-3305
(801) 375-4263
(801) 429-8085
Mailing address
61 W 13490 S STE 100, DRAPER, UT 84020-7299
(801) 997-5770
(435) 723-3391
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
OP60232831
WA
207XS0106X
Orthopaedic Hand Surgery Physician
Primary
10858427-1204
UT
207XS0106X
Orthopaedic Hand Surgery Physician
OP60232831
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10858427-1204
LICENSE
UT
Enumeration date
05/17/2007
Last updated
09/04/2024
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