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Individual

DR. CLARK E PETERSEN

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1544 W ANTELOPE DR, LAYTON, UT 84041-1146
(801) 773-3339
(801) 773-6727
Mailing address
2551 LEWIS PARK DR, BOUNTIFUL, UT 84010-5762
(801) 299-1215

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
3609501205
UT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
87057151003
UT
Enumeration date
12/15/2005
Last updated
07/08/2007
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