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Organization

UNIVERSITY OF UTAH DEPARTMENT OF OB-GYN

Active
Organization subpart
No

Provider details

NPI number
Authorized official
C. MATTHEW PETERSON MD (DEPARTMENT CHAIR)
(801) 581-2719
Entity
Organization

Contact information

Practice address
50 N MEDICAL DR, SALT LAKE CITY, UT 84132-0001
(801) 581-2719
Mailing address
PO BOX 413028, SALT LAKE CITY, UT 84141-3028
(801) 213-3900

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
207VC0200X
Critical Care Medicine (Obstetrics & Gynecology) Physician
207VG0400X
Gynecology Physician
207VX0000X
Obstetrics Physician

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
003022600
IDAHO MEDICAID
ID
01
100503086
NEVADA MEDICAID
NV
01
121965100
WYOMING MEDICAID
WY
Enumeration date
06/25/2006
Last updated
11/15/2012
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