Individual
GARY PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1380 E MEDICAL CENTER DR, STE # 4100, ST GEORGE, UT 84790-2156
(435) 251-2900
(435) 251-2916
Mailing address
1380 E MEDICAL CENTER DR, STE # 4100, ST GEORGE, UT 84790-2156
(435) 251-2900
(435) 251-2916
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
154580-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100507061
—
UT
Enumeration date
06/08/2006
Last updated
09/05/2008
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