Individual
ANDREW D PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
524 W 300 N STE 203, PROVO, UT 84601-2669
(801) 607-5268
(801) 607-5271
Mailing address
524 W 300 N STE 203, PROVO, UT 84601-2669
(801) 607-5268
(801) 607-5271
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
8382699-1204
UT
207Q00000X
Family Medicine Physician
M4441
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
184033201
—
TX
01
—
207Q00000X
TAXONOMY
KS
Enumeration date
08/31/2005
Last updated
05/21/2014
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