Individual
DR. MARK WILLIAM PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2200 PARK AVE. BLDG. D STE. 100, PARK CITY, UT 84060
(435) 615-8822
(435) 615-8823
Mailing address
101 SUN MEADOW DR, CENTERTON, AR 72719-9610
(479) 795-0426
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
5101018542
MI
207Q00000X
Family Medicine Physician
E7679
AR
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
8743560-1204
UT
390200000X
Student in an Organized Health Care Education/Training Program
5101018542
MI
Other
Enumeration date
10/22/2009
Last updated
02/18/2020
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