Individual
DR. JONATHAN RICHARD PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
24 S 1100 E STE 101, SALT LAKE CITY, UT 84102-1562
(801) 355-6468
(801) 355-3450
Mailing address
24 S 1100 E STE 101, SALT LAKE CITY, UT 84102-1562
(801) 355-6468
(801) 355-3450
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
2019-00197
NC
207X00000X
Orthopaedic Surgery Physician
Primary
6547620-1205
UT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/18/2016
Last updated
09/14/2022
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