Individual
DR. ROBERT G PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
370 NINTH AVE, SUITE 111, SALT LAKE CITY, UT 84103-2877
(801) 408-2233
(801) 408-2870
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(801) 442-1900
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
1800341205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107004866104
INTERMOUNTAIN HEALTHCARE
UT
01
—
18541
PUBLIC EMPLOYEES (PEHP)
UT
01
—
20110
DESERET MUTUAL (DMBA)
UT
01
—
870639983PE2
EDUCATORS MUTUAL (EMIA)
UT
Enumeration date
03/25/2006
Last updated
09/02/2011
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