Individual
LEE M PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3550 N UNIVERSITY AVE, SUITE 250, PROVO, UT 84604
(801) 374-9625
(801) 374-9690
Mailing address
3550 N UNIVERSITY AVE, SUITE 250, PROVO, UT 84604
(801) 374-9625
(801) 374-9690
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
1766331205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
870516264009
—
UT
Enumeration date
06/07/2006
Last updated
07/10/2007
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