Individual
MARCUS L PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
676 S BLUFF ST, #207, ST GEORGE, UT 84770-3568
(435) 628-2895
(435) 628-5943
Mailing address
676 S BLUFF ST, #207, ST GEORGE, UT 84770-3568
(435) 628-2895
(435) 628-5943
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
183446-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107007770102
IHC
UT
01
—
107029664101
IHC
UT
01
—
19344612000001
REGENCE
UT
01
—
201302841
CURRENT TAX ID
UT
01
—
201302841793981
US HEALTH
UT
01
—
201302847
OTHER ID
UT
01
—
2085401
BCBS NV
NV
01
—
870436699
OLD TAX ID
UT
01
—
902568
DMBA
UT
Enumeration date
05/12/2006
Last updated
09/17/2012
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