Individual
SAMUEL R PETERSON
Active
Individual
SAMUEL R PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
52631431205
UT
207N00000X
Dermatology Physician
Primary
C148028
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03.00174
UNITED HEALTHCARE
UT
01
—
107017630101
IHC HEALTHPLANS
UT
01
—
72756
PEHP
UT
01
—
796725
DMBA
UT
05
—
870281028000
—
UT
01
—
P00066498
PALMETTO GBA
UT
01
—
QM0000066345
ALTIUS
UT
Enumeration date
05/04/2006
Last updated
01/19/2023
Update your record
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