Organization
MICHAEL J. PETERSON M.D LLC
Active
Other names
HERRIMAN FAMILY MEDICINE
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL J PETERSON M.D. (OWNER/PHYSICIAN)
(801) 253-4001
Entity
Organization
Contact information
Practice address
5746 W 13400 S, HERRIMAN, UT 84096-6907
(801) 253-4001
(801) 253-4003
Mailing address
5746 W 13400 S, HERRIMAN, UT 84096-6907
(801) 253-4001
(801) 253-4003
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5354110-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
079585401001
—
UT
Enumeration date
01/09/2008
Last updated
10/07/2008
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