Individual
DEREK PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2240 ADAMS AVE, OGDEN, UT 84401-1511
(801) 393-5355
Mailing address
2240 ADAMS AVE, OGDEN, UT 84401-1511
(801) 393-5355
(801) 394-4609
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10232646-1206
UT
Other
Enumeration date
02/23/2017
Last updated
02/03/2026
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