Individual
DR. JASON DAYNE PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5353 S 960 E, #150, SALT LAKE CITY, UT 84117-3569
(801) 261-5791
(801) 747-7740
Mailing address
5353 S 960 E, #150, SALT LAKE CITY, UT 84117-3569
(801) 971-8684
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
83185641205
UT
2082S0099X
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
Primary
83185641205
UT
Other
Enumeration date
02/15/2008
Last updated
08/07/2012
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