Organization
J. DAYNE PETERSEN M.D., PC
Active
Other names
NuVista Plastic Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON DAYNE PETERSEN M.D. (PRESIDENT)
(801) 971-8684
Entity
Organization
Contact information
Practice address
5353 S 960 E, #150, SALT LAKE CITY, UT 84117-3569
(801) 261-5791
(801) 747-7740
Mailing address
5353 S 960 E, #150, SALT LAKE CITY, UT 84117-3569
(801) 261-5791
(801) 747-7740
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
83185641205
UT
Other
Enumeration date
08/07/2012
Last updated
08/30/2012
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