Individual
WALLACE CURTIS PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 N MEDICAL DR, SALT LAKE CITY, UT 84113-1103
(801) 993-9551
(801) 733-5872
Mailing address
1954 FORT UNION BLVD, #111, SALT LAKE CITY, UT 84121-6800
(801) 993-9551
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
168281-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107006366101
IHC
UT
01
—
2000040
UNITED HEALTHCARE
UT
01
—
2330
HEALTHY U
UT
01
—
24409
PEHP
UT
05
—
401765
—
MT
01
—
416944
DESERET MUTUAL
UT
05
—
710287
—
AZ
01
—
870280408PE2
EDUCATORS MUTUAL
UT
01
—
PR00612
MOLINA
UT
01
—
QM0000049533
ALTIUS
UT
Enumeration date
08/25/2006
Last updated
07/08/2007
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