Individual
SAMUEL R PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
360 SAN MIGUEL DR STE 309, NEWPORT BEACH, CA 92660-7829
(949) 640-0434
Mailing address
600 CORPORATE DR, STE 100, LADERA RANCH, CA 92694-2107
(949) 388-8022
(949) 388-8033
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
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us