Individual
JESSICA PETROVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4745 S 3200 W, TAYLORSVILLE, UT 84129-2822
(801) 964-6214
(877) 497-4661
Mailing address
2621 S 3270 W, WEST VALLEY CITY, UT 84119-1119
(385) 261-2737
(877) 497-4661
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
10964121-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
74-2412898
—
UT
Enumeration date
08/14/2013
Last updated
06/04/2020
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