Individual
DR. BRIAN R PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3584 W 9000 S, SUITE 311, WEST JORDAN, UT 84088-5710
(801) 566-8304
(801) 566-8304
Mailing address
3584 W 9000 S, SUITE 311, WEST JORDAN, UT 84088-5710
(801) 566-8304
(801) 566-8304
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
036142390
IL
207YX0901X
Otology & Neurotology Physician
Primary
313974-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
214881
MEDICARE GROUP PTAN
IL
Enumeration date
07/05/2006
Last updated
11/02/2020
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